US20030162758A1 - Treatment for age-related macular degeneration (AMD) - Google Patents

Treatment for age-related macular degeneration (AMD) Download PDF

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US20030162758A1
US20030162758A1 US10/313,641 US31364102A US2003162758A1 US 20030162758 A1 US20030162758 A1 US 20030162758A1 US 31364102 A US31364102 A US 31364102A US 2003162758 A1 US2003162758 A1 US 2003162758A1
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Daniel Schwartz
Keith Duncan
Kathy Bailey
John Kane
Brian Ishida
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University of California
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Priority to US10/428,551 priority patent/US20030229062A1/en
Assigned to REGENTS OF THE UNIVERSITY OF CALIFORNIA, THE reassignment REGENTS OF THE UNIVERSITY OF CALIFORNIA, THE ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: SCHWARTZ, DANIEL M., DUNCAN, KEITH G., KANE, JOHN P., ISHIDA, BRIAN Y., BAILEY, KATHY R.
Publication of US20030162758A1 publication Critical patent/US20030162758A1/en
Priority to US10/794,198 priority patent/US7470659B2/en
Priority to US11/055,309 priority patent/US7470660B2/en
Priority to US12/245,944 priority patent/US20100047330A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid, pantothenic acid
    • A61K31/198—Alpha-aminoacids, e.g. alanine, edetic acids [EDTA]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/192—Carboxylic acids, e.g. valproic acid having aromatic groups, e.g. sulindac, 2-aryl-propionic acids, ethacrynic acid 
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/20—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids
    • A61K31/203—Retinoic acids ; Salts thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/38—Heterocyclic compounds having sulfur as a ring hetero atom
    • A61K31/381—Heterocyclic compounds having sulfur as a ring hetero atom having five-membered rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/575—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of three or more carbon atoms, e.g. cholane, cholestane, ergosterol, sitosterol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/58—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids containing heterocyclic rings, e.g. danazol, stanozolol, pancuronium or digitogenin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A61P27/04—Artificial tears; Irrigation solutions

Definitions

  • the present invention is directed to the fields of ophthalmology and cell biology. Specifically, the invention regards treatment of age-related macular degeneration (AMD) utilizing regulation of reverse cholesterol transport.
  • AMD age-related macular degeneration
  • Age-related macular degeneration is the leading cause of severe visual loss in the developed world (Taylor et al., 2001; VanNewkirk et al., 2000).
  • AMD Age-related macular degeneration
  • Bruch's membrane lies at the critical juncture between the outer retina and its blood supply, the choriocapillaris.
  • Lipid deposition causes reduced hydraulic conductivity and macromolecular permeability in Bruch's membrane and is thought to impair retinal metabolism (Moore et al., 1995; Pauleikhoff et al., 1990; Starita et al., 1996).
  • Retina and/or RPE may respond by elaboration of angiogenic factors (e.g. VEGF, vFGF) that promote growth of choroidal neovascularization.
  • VEGF vascular endothelial growth factor
  • lipid accumulation in Bruch's membrane similar to that in AMD has been observed in apolipoprotein E (apo E) null mice (Dithmar et al., 2000; Kliffen et al., 2000). Because of the additional association between apo E alleles and other age-related degenerations, Alzheimer's disease and atherosclerosis, there has been recent investigation into a potential role for apo E in AMD.
  • apo E apolipoprotein E null mice
  • apo E has several functions that may affect the course of this disease.
  • Apo E has anti-angiogenic (Browning et al., 1994), anti-inflammatory (Michael et al., 1994), and anti-oxidative effects (Tangirala et al., 2001). These are all considered atheroprotective attributes of Apo E, but may also be important in protecting against progression of AMD. While atheroprotective effects of apo E were initially thought to stem from effects on plasma lipid levels, local effects on vascular macrophages are probably equally important.
  • Apo E expression increases cholesterol efflux to HDL3 in J774 macrophages (Mazzone and Reardon, 1994) and lipid free apolipoprotein A1 (Langer et al., 2000).
  • Cell surface apo E is also hypothesized to induce efflux from the plasma membrane (Lin et al., 1999).
  • Reverse cholesterol transport may be important in the pathogenesis of AMD because of lipid efflux from RPE into Bruch's membrane.
  • RPE cells progressively accumulate lipid deposits throughout life; however, unlike vessel wall macrophages, the source of RPE lipid is thought to be retinal photoreceptor outer segments (POS) (Kennedy et al., 1995). Every day, each RPE cell phagocytoses and degrades more than one thousand POS via lyzosmal enzymes. These POS are enriched in phospholipid and contain the photoreactive pigment, rhodopsin. Incompletely digested POS accumulate as lipofuscin in RPE. By age 80, approximately 20% of RPE cell volume is occupied by lipofuscin (Feeney-Burns et al., 1984).
  • Nuclear hormone receptor ligands regulate reverse cholesterol transport in macrophages via their effects on ABCA-1 and apo E expression.
  • Liver X receptor (LXR) and/or retinoid X receptor (RXR) ligands increase levels of these transporters and increase reverse cholesterol transport in macrophages (Mak et al., 2002; Laffitte et al., 2001).
  • Thyroid hormone has also been demonstrated to increase expression of apo E three fold in HepG2 cells (Laffitte et al., 1994).
  • Mullins et al. (2000) describe compositional similarity between drusen and other extracellular deposits, including atherosclerotic plaques. Specifically, vitronectin, amyloid P, Apo E, and lipids are among the constituents shared in common. More specifically, apolipoprotein E is identified in retinal pigmented epithelium.
  • U.S. Pat. No. 6,071,924 regards inhibition of proliferation of retinal pigment epithelium by contacting RPE cells with a retinoic acid receptor agonist, except for retinoic acid, preferably thereby inhibiting AP-1-dependent gene expression.
  • an AP1 antagonist is delivered to a subject in need thereof for inhibition of proliferation of retinal pigment epithelium or a disease associated therewith.
  • the related U.S. Pat. No. 6,075,032 is directed to inhibition of choroidal neovascularization by contacting RPE cells with an AP-1 antagonist.
  • 5,824,685 regards amelioration of proliferative vitreoretinopathy or traction retinal detachment by contacting RPE cells with a retinoic acid receptor selected from ethyl-6-[2-(4,4-dimethylthiochroman-6-yl)ethynyl]nicotinate, 6-[2-(4,4-dimethylchroman-6-yl)ethynyl]nicotinic acid, and p-[(E)-2-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthyl)propenyl]-benzoic acid.
  • the related U.S. Pat. No. 6,372,753 addresses inhibition of an ocular disease resulting from proliferation of retinal pigment epithelium by providing at least one AP-1 antagonist and at least one retinoic acid receptor (RAR) agonist, except for retinoic acid.
  • RAR retinoic acid receptor
  • WO 01/58494 is directed to treating or preventing an ocular disease, such as age-related macular degeneration, by contacting an ocular cell with an expression vector comprising a nucleic acid sequence encoding an inhibitor of angiogenesis and a neurotrophic agent.
  • an ocular disease such as age-related macular degeneration
  • an expression vector comprising a nucleic acid sequence encoding an inhibitor of angiogenesis and a neurotrophic agent.
  • the inhibitor of angiogenesis and the neurotrophic agent are one and the same, such as pigment epithelium-derived factor (PEDF).
  • PEDF pigment epithelium-derived factor
  • WO 02/13812 regards the use of an insulin-sensitizing agent, preferably peroxisome proliferator-activated receptor- ⁇ (PPAR ⁇ ) agonists, for the treatment of an inflammatory disease, such as an ophthalmic disease.
  • an insulin-sensitizing agent preferably peroxisome proliferator-activated receptor- ⁇ (PPAR ⁇ ) agonists
  • PPAR ⁇ peroxisome proliferator-activated receptor- ⁇
  • WO 00/52479 addresses diagnosing, treating, and preventing drusen-associated disorders (any disorder which involves drusen formation), including AMD.
  • drusen-associated disorders any disorder which involves drusen formation
  • the present invention provides a novel approach to reduce lipid content of ocular tissue, such as Bruch's membrane and further provides methods and compositions for the treatment of macular degeneration, such as AMD.
  • the present invention is directed to a system, method, and/or composition(s) related to treating AMD.
  • Treatments for dry AMD have been lacking, because the pathogenesis of this common condition is poorly understood, and the inventors have demonstrated analogous biological behavior between human retinal pigment epithelial (RPE) cells and macrophages that point toward similar pathogenic mechanisms of AMD and atherosclerosis.
  • RPE retinal pigment epithelial
  • RCT reverse cholesterol transport
  • the present inventors provide the novel demonstration of RCT in RPE cells in the eye.
  • RCT is regulated through manipulation of levels of cholesterol and/or phospholipid transporters (ABCA-1, Apo E, SRB-1, SRB-2) by nuclear hormone receptor ligands such as agonists of thyroid hormone (TR), liver X receptor (LXR), and/or retinoid X receptor (RXR).
  • a goal for the present invention is the reduction of lipid content of RPE Bruch's membrane to facilitate an improvement in visual function and/or, in some embodiments, prevent ocular disease, such as AMD.
  • Reduction of the lipid content of Bruch's membrane preferably results in at least one or more of the following: reduction in development of CNV; improvement in dark adaptation; improvement in night vision; improved visual acuity; and/or improved recovery to bright flash stimulus.
  • a nuclear hormone agonist such as thyroid hormone (TR) agonist (for example, T3 (3,5,3′-L-triiodothyronine), TRIAC (3-triiodothyoacetic acid), GC1, KB-000,141 and/or KB141 (Karo Bio; Huddinge, Sweden).
  • TR thyroid hormone
  • TRIAC tridecylcholine
  • GC1 KB-000,141 and/or KB141
  • the agonist binds to at least one nuclear hormone receptor in the RPE and induces upregulation of RCT.
  • Efflux of lipid from RPE increases, and the likelihood of visual loss from choroidal neovascularization is reduced.
  • Other nuclear hormone receptor ligands of the TR, RXR, and LXR families, for example, which are well known in the art, are used independently or in combination with each other to enhance RCT by RPE.
  • ocular tissue is retinal pigment epithelium (RPE), Bruch's membrane, or a combination thereof.
  • the nuclear hormone receptor is thyroid hormone receptor.
  • the ligand of thyroid hormone receptor is 3,5,3′-L-triiodothyronine (T3), TRIAC (3-triiodothyroacetic acid); KB141; GC-1; 3, 5 dimethyl-3-isopropylthyronine; or a mixture thereof.
  • the nuclear hormone receptor is liver X receptor.
  • the ligand of liver X receptor is 22 (R) hydroxycholesterol; acetyl-podocarpic dimer; T0901317; GW3965 (12); 24(S),25-epoxycholesterol; 24(R),25-epoxycholesterol; 22(R)-ol-24(S),25-epoxycholesterol; 22(S)-ol,24(R),25-epoxycholesterol; 24(S),25-iminocholesterol; methyl-H-cholenate; dimethyl-hydroxycholenamide; 24(S)-hydroxycholesterol; 24(R)-hydroxycholesterol; 22(S)-hydroxycholesterol; 22(R),24(S)-dihydroxycholesterol; 25-hydroxycholesterol; 24(S),25-dihydroxycholesterol; 24(R),25-dihydroxycholesterol; 24,25-dehydrocholesterol; 7(a)
  • the nuclear hormone receptor is retinoid X receptor, ligands of which include 9 cis-retinoic acid;
  • AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid];
  • AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid];
  • AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-tetrahydronaphthalen-2-yl) (5 carboxypyrid-2-yl)sulfide]; LGD346; LG100268; LG100754; BMS649; bexaroteneR (4-[1-(5,6,
  • the ocular tissue is comprised in an individual, such as one at risk for developing macular degeneration or another ocular disease, and/or the ocular tissue is comprised in individuals afflicted with macular degeneration (for example, age-related macular degeneration).
  • the individual is afflicted with Stargardts disease (fundus flavimaculatus) or is at risk for developing Stargardts disease.
  • a method of increasing reverse cholesterol transport in an ocular tissue comprising the step of delivering to the tissue at least one ligand of a nuclear hormone receptor.
  • the ocular tissue is retinal pigment epithelium (RPE), Bruch's membrane, or a combination thereof.
  • ALD macular degeneration
  • the delivering occurs under conditions wherein reverse cholesterol transport is upregulated.
  • kits for the treatment of macular degeneration housed in a suitable container, comprising a ligand of a nuclear hormone receptor.
  • the nuclear hormone receptor is TR, RXR, LXR, or a combination thereof.
  • it is useful to comprise a combination of nuclear hormone receptors since it is well known in the art that many are heterodimers (for example, LXR and RXR, or RXR and TR).
  • the kit comprises a pharmaceutically acceptable excipient.
  • the ligand for a nuclear hormone receptor is comprised in the pharmaceutically acceptable excipient.
  • ALD macular degeneration
  • FIG. 1 shows that RPE cells express Apo E, ABCA1, and LXR ⁇ .
  • FIG. 2 shows RPE cell expression of SR-BI and SR-BII.
  • FIG. 3 illustrates SR-BI and SR-BII immunofluorescence in RPE cells.
  • FIG. 4 demonstrates ABCA1 immunofluorescence in RPE cells.
  • FIG. 5 demonstrates that basal Apo E expression is greater than apical Apo E expression in cultured human RPE cells.
  • FIG. 6 shows regulation of Apo E expression by nuclear hormone receptor ligands.
  • FIG. 7 provides a non-denatured polyacrylamide gel of lipoprotein fractions.
  • FIG. 8 shows 14 C distributeion of the fractions from FIG. 7.
  • FIG. 9 demonstrates thin layer chromatography illustrating the identification of six out of seventeen spots of an HDL fraction.
  • HDL is the high density lipoprotein fraction
  • POS is labeled POS starting material
  • PC is phophatidylcholine
  • PI is phosphatidylinisotol
  • PE is phosphatidylethanolamine
  • C cholesterol
  • TRL is TG rich lipid, including triglycerides and cholesterol ester.
  • FIG. 10 demonstrates that 14 C counts increase following drug treatments that increase RCT.
  • FIG. 11 illustrates ABCA1 regulation by RXR and LXR ligands.
  • FIG. 12 shows HDL, LDL and plasma stimulation of 14 C-labeled lipid transport the identification of HDL from RPE cells.
  • FIG. 13 shows stimulation of CD36 expression by oxidized lipid.
  • a” or “an” may mean one or more.
  • the words “a” or “an” when used in conjunction with the word “comprising”, the words “a” or “an” may mean one or more than one.
  • another may mean at least a second or more.
  • age-related macular degeneration refers to macular degeneration in an individual over the age of about 50. In one specific embodiment, it is associated with destruction and loss of the photoreceptors in the macula region of the retina resulting in decreased central vision and, in advanced cases, legal blindness.
  • Bruch's membrane refers to a five-layered structure separating the choriocapillaris from the RPE.
  • the term “increase lipid efflux” or “increasing lipid efflux” as used herein refers to an increased level and/or rate of lipid efflux, promoting lipid efflux, enhancing lipid efflux, facilitating lipid efflux, upregulating lipid efflux, improving lipid efflux, and/or augmenting lipid efflux.
  • the efflux comprises efflux of phospholipid, triglyceride, cholesterol, and/or cholesterol ester.
  • acula refers to the light-sensing cells of the central region of the retina.
  • macular degeneration refers to deterioration of the central portion of the retina, the macula.
  • nuclear hormone receptor refers to an intracellular receptor that plays a role in expression of gene(s) involved in physiological processes, examples of which include cell growth and differentiation, development, and homeostasis.
  • these receptors are members of a superfamily of receptors, whose members recognize similar DNA sequences that contain two or more hexanucleotide DNA-binding half-sites arranged as direct repeats or inverted repeats. It is through this recognition that these receptors are able to regulate the expression of genes in the nucleus, and thereby regulate the respective physiological process.
  • nuclear hormone receptors include thyroid hormone receptor, liver X receptor, retinoid X receptor, estrogen receptor, androgen receptor, peroxisome proliferator activated receptors (PPARs), trans-retinoic acid receptor (RAR), the vitamin D receptor (VDR), glucocorticoid receptor, the progesterone receptor, and isoforms thereof.
  • Nuclear hormone receptors in some embodiments include those that remain sequestered in the cytoplasm in the absence of their cognate ligands (e.g., steroid hormone receptors). Upon binding of the ligand, the steroid hormone receptors are translocated to the nucleus where they bind to hormone response elements, typically as homodimers.
  • ligands e.g., steroid hormone receptors
  • the nuclear hormone receptors are not sequestered in the cytoplasm in the absence of their ligands, but rather remain in the nucleus.
  • These receptors which include the thyroid hormone, retinoid, fatty acid, and eicosanoid receptors, typically bind to their cognate response elements as heterodimers with, for example, a 9-cis-retinoic acid receptor (RXR).
  • RXR 9-cis-retinoic acid receptor
  • binding of a nuclear receptor to a response element occurs in the absence of the cognate ligand.
  • An example of such a nuclear receptor is the famesoid X receptor (FXR).
  • reverse cholesterol transport refers to transport of cholesterol from peripheral tissues to the liver. In a specific embodiment, it refers to efflux of lipid from RPE cells. In specific embodiments, it comprises efflux of cellular cholesterol and/or phospholipid to HDL, and, in further specific embodiments, it comprises HDL delivery of cholesterol ester to the liver, such as for biliary secretion.
  • upregulate as used herein is defined as increasing the level and/or rate of an event, process, or mechanism, such as reverse cholesterol transport.
  • the inventors Using cell culture methods to study lipid metabolism, the inventors have, shown a number of analogous mechanisms for lipid metabolism that are shared by macrophages and human RPE cells. The shared biology of these two cell types indicates useful therapeutic approaches for treatment of AMD. Specifically, the present inventors are the first to show that RCT occurs in RPE cells, and enhancement of RCT is beneficial for removing undesired lipid from the RPE cells and/or Bruch's membrane to facilitate retinal metabolism.
  • the transporters in the RCT system are regulated to improve RCT.
  • this regulatory aspect of the present invention provides a novel treatment for AMD.
  • the present invention provides the novel idea in the field in which reverse cholesterol transport occurs in RPE cells.
  • the invention provides methods and compositions related to facilitating efflux of cholesterol and/or phospholipids from inside an RPE cell to the outside of the RPE cell, and further through Bruch's membrane.
  • following efflux from Bruch's membrane the cholesterol and/or phospholipids are transported by apolipoprotein E, apolipoprotein A1, and other transporters, or a combination thereof, to HDL for removal to the liver.
  • RCT reverse cholesterol transport
  • a transporter of lipid from RPE cells is enhanced for the transport activity, such as by an increase in the level of the transporter.
  • transporters include apo E, ABCA1, SR-BI, SR-BII, ABCA4, ABCG5, ABCG8; other proteins that might be involved are LCAT, CETP, PLTP, LRP receptor, LDL receptor, Lox-1, and lipases.
  • lox-1 and PLTP are expressed in RPE, as demonstrated by RT_PCR.
  • apo A1 is utilized to facilitate RCT from RPE cells.
  • apo A1 is made by RPE cells.
  • SR-B has been reported to be upregulated by 17beta-Estradiol and testosterone.
  • HDL binding to effluxed lipids is enhanced, thereby increasing efflux of lipids from Bruch's membrane into the circulation and providing therapy for AMD.
  • an increase in HDL levels is utilized to facilitate lipid efflux from RPE cells and/or Bruch's membrane, and in a specific embodiment, levels of specific subspecies of HDL are utilized to facilitate lipid efflux.
  • effluxed lipids could bind to pre ⁇ -HDL, HDL1, HDL2 or HDL3. Effluxed lipids could also bind prebeta-1, prebeta-2, prebeta-3, and/or prebeta-4 HDL. In a specific embodiment, the effluxed lipids bind preferentially to HDL2 that comprises apo E.
  • RCT components are present in RPE cells (Mullins et al., 2000; Anderson et al., 2001).
  • Nuclear hormone receptors known to regulate expression of reverse cholesterol transport proteins are also expressed in cultured human RPE.
  • ligands to at least one of the nuclear hormone receptors upregulates RCT.
  • the lipids bind HDL, so in an embodiment of the present invention there is upregulation of HDL for AMD treatment, such as by statins and/or niacin.
  • treatment for AMD comprises reduction of RCT.
  • RCT Reduction of RCT
  • the transporters are preferentially inhibited.
  • HDL is unable to enter Bruch's membrane to remove the lipids and the RPE continues to efflux lipids.
  • lipid efflux by RPE is inhibited to maintain macromolecular transport across Bruch's membrane. Inhibition of RCT by reducing levels of ABCA-1, apo E, and/or SRB-1, or SRB-2 would reduce accumulation of lipid in Bruch's membrane.
  • ligands for nuclear hormone receptors are utilized as compounds for enhancing RCT for the reduction of lipid content of RPE and Bruch's membrane.
  • the nuclear hormone receptor ligands are utilized for treatment of AMD.
  • the nuclear hormone receptors comprise TR, RXR, and/or LXR.
  • ligands of the nuclear hormone receptors are delivered to at least one RPE cell to facilitate efflux of lipids from the RPE cell and/or are delivered to Bruch's membrane for efflux from Bruch's membrane.
  • ligands for TR include T3 (3,5,3′-L-triiodothyronine).
  • TR ligands include but are not limited to TRIAC (3-triiodothyroacetic acid); KB141 (Karo Bio); GC-1; and 3, 5 dimethyl-3-isopropylthyronine.
  • ligands for RXR include 9 cis-retinoic acid, and other RXR ligands also include but are not limited to: AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid]; AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid]; AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-t
  • expression of a sequence is monitored following administration of an upregulator of its expression or a compound suspected to be an upregulator.
  • an upregulator of its expression or a compound suspected to be an upregulator such as commercially from Celera Genomics, Inc. (Rockville, Md.) or from the National Center for Biotechnology Information's GenBank database.
  • Exemplary apo E polynucleotide sequences include the following, cited with their GenBank Accession number: SEQ ID NO:1 (K00396); SEQ ID NO:2 (M10065); and SEQ ID NO:3 (M12529).
  • exemplary apo E polypeptide sequences include the following, cited with their GenBank Accession number: SEQ ID NO:4 (AAB59546); SEQ ID NO:5 (AAB59397); and SEQ ID NO:6 (AAB59518).
  • sequences of ABCA- 1 are utilized, such as to monitor ABCA-1 expression related to methods of the present invention.
  • Some examples of ABCA1 polynucleotides include SEQ ID NO:7 (NM — 005502); and SEQ ID NO:8 (AB055982).
  • Some examples of ABCA1 polypeptides include SEQ ID NO:9 (NP — 005493); and SEQ ID NO:10 (BAB63210).
  • SR-BI polynucleotide is SEQ ID NO:11 (NM — 005505) and an example of a SR-BI polypeptide is SEQ ID NO:12 (NP — 005496).
  • compositions of the present invention may have an effective amount of a compound for therapeutic administration and, in some embodiments, in combination with an effective amount of a second compound that is also an anti-AMD agent.
  • the compound is a ligand/agonist of a nuclear hormone receptor.
  • compounds that upregulate expression of HDL are the compounds for therapeutic administration.
  • Such compositions will generally be dissolved or dispersed in a pharmaceutically acceptable carrier or aqueous medium.
  • phrases “pharmaceutically or pharmacologically acceptable” refer to molecular entities and compositions that do not produce an adverse, allergic or other untoward reaction when administered to an animal, or human, as appropriate.
  • pharmaceutically acceptable carrier includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents and the like. The use of such media and agents for pharmaceutical active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredients, its use in the therapeutic compositions is contemplated. Supplementary active ingredients, such as other anti-AMD agents, can also be incorporated into the compositions.
  • other pharmaceutically acceptable forms include, e.g., tablets or other solids for oral administration; time release capsules; and any other form currently used, including cremes, lotions, mouthwashes, inhalants and the like.
  • the delivery vehicles of the present invention may include classic pharmaceutical preparations. Administration of these compositions according to the present invention will be via any common route so long as the target ocular tissue is available via that route. This includes oral, nasal, buccal, rectal, vaginal or topical. Alternatively, administration may be by orthotopic, intradermal, subcutaneous, intramuscular, intraperitoneal or intravenous injection. Such compositions would normally be administered as pharmaceutically acceptable compositions. In some embodiments, the compositions are administered by sustained release intra- or extra-ocular devices.
  • the vehicles and therapeutic compounds therein of the present invention are advantageously administered in the form of injectable compositions either as liquid solutions or suspensions; solid forms suitable for solution in, or suspension in, liquid prior to injection also may be prepared. These preparations also may be emulsified.
  • a typical composition for such purposes comprises a 50 mg or up to about 100 mg of human serum albumin per milliliter of phosphate buffered saline.
  • Other pharmaceutically acceptable carriers include aqueous solutions, non-toxic excipients, including salts, preservatives, buffers and the like. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oil and injectable organic esters, such as theyloleate.
  • Aqueous carriers include water, alcoholic/aqueous solutions, saline solutions, parenteral vehicles such as sodium chloride, Ringer's dextrose, etc.
  • Intravenous vehicles include fluid and nutrient replenishers.
  • Preservatives include antimicrobial agents, anti-oxidants, chelating agents and inert gases. The pH and exact concentration of the various components in the pharmaceutical are adjusted according to well-known parameters.
  • unit dose refers to a physically discrete unit suitable for use in a subject, each unit containing a predetermined quantity of the therapeutic composition calculated to produce the desired response in association with its administration, i.e., the appropriate route and treatment regimen.
  • the quantity to be administered both according to number of treatments and unit dose, depends on the subject to be treated, the state of the subject and the protection desired. Precise amounts of the therapeutic composition also depend on the judgment of the practitioner and are peculiar to each individual.
  • kits All of the essential materials and reagents required for AMD treatment, diagnosis and/or prevention may be assembled together in a kit.
  • the liquid solution preferably is an aqueous solution, with a sterile aqueous solution being particularly preferred.
  • an anti-AMD agent may be formulated into a single or separate pharmaceutically acceptable syringeable composition.
  • the container means may itself be an inhalant, syringe, pipette, eye dropper, or other such like apparatus, from which the formulation may be applied to an infected area of the body, such as the lungs, injected into an animal, or even applied to and mixed with the other components of the kit.
  • kits of the invention may also be provided in dried or lyophilized forms.
  • reagents or components are provided as a dried form, reconstitution generally is by the addition of a suitable solvent. It is envisioned that the solvent also may be provided in another container means.
  • the kits of the invention may also include an instruction sheet defining administration of the anti-AMD composition.
  • kits of the present invention also will typically include a means for containing the vials in close confinement for commercial sale such as, e.g., injection or blow-molded plastic containers into which the desired vials are retained.
  • a means for containing the vials in close confinement for commercial sale such as, e.g., injection or blow-molded plastic containers into which the desired vials are retained.
  • the kits of the invention also may comprise, or be packaged with, an instrument for assisting with the injection/administration or placement of the ultimate complex composition within the body of an animal.
  • an instrument may be an inhalant, syringe, pipette, forceps, measured spoon, eye dropper or any such medically approved delivery vehicle.
  • the active compounds of the present invention will often be formulated for parenteral administration, e.g., formulated for injection via the intravenous, intramuscular, subcutaneous, or even intraperitoneal routes.
  • parenteral administration e.g., formulated for injection via the intravenous, intramuscular, subcutaneous, or even intraperitoneal routes.
  • the preparation of an aqueous composition that contains a second agent(s) as active ingredients will be known to those of skill in the art in light of the present disclosure.
  • such compositions can be prepared as injectables, either as liquid solutions or suspensions; solid forms suitable for using to prepare solutions or suspensions upon the addition of a liquid prior to injection can also be prepared; and the preparations can also be emulsified.
  • Solutions of the active compounds as free base or pharmacologically acceptable salts can be prepared in water suitably mixed with a surfactant, such as hydroxypropylcellulose. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, and mixtures thereof and in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms.
  • the pharmaceutical forms suitable for injectable use include sterile aqueous solutions or dispersions; formulations including sesame oil, peanut oil or aqueous propylene glycol; and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions.
  • the form must be sterile and must be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms, such as bacteria and fungi.
  • the active compounds may be formulated into a composition in a neutral or salt form.
  • Pharmaceutically acceptable salts include the acid addition salts (formed with the free amino groups of the protein) and which are formed with inorganic acids such as, for example, hydrochloric or phosphoric acids, or such organic acids as acetic, oxalic, tartaric, mandelic, and the like. Salts formed with the free carboxyl groups can also be derived from inorganic bases such as, for example, sodium, potassium, ammonium, calcium, or ferric hydroxides, and such organic bases as isopropylamine, trimethylamine, histidine, procaine and the like.
  • the carrier can also be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), suitable mixtures thereof, and vegetable oils.
  • the proper fluidity can be maintained, for example, by the use of a coating, such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants.
  • the prevention of the action of microorganisms can be brought about by various antibacterial and/or antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like.
  • isotonic agents for example, sugars or sodium chloride.
  • Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin.
  • the therapeutic formulations of the invention could also be prepared in forms suitable for topical administration, such as in eye drops, cremes and lotions.
  • solutions Upon formulation, solutions will be administered in a manner compatible with the dosage formulation and in such amount as is therapeutically effective.
  • the formulations are easily administered in a variety of dosage forms, such as the type of injectable solutions described above, with even drug release capsules and the like being employable.
  • aqueous solutions for parenteral administration in an aqueous solution, for example, the solution should be suitably buffered if necessary and the liquid diluent first rendered isotonic with sufficient saline or glucose.
  • aqueous solutions are especially suitable for intraocular, intravenous, intramuscular, and subcutaneous administration.
  • sterile aqueous media that can be employed will be known to those of skill in the art in light of the present disclosure.
  • one dosage could be dissolved in 1 mL of isotonic NaCl solution and either added to 1000 mL of hypodermoclysis fluid or injected at the proposed site of infusion, (see for example, “Remington's Pharmaceutical Sciences” 15th Edition, pages 1035-1038 and 1570-1580). Some variation in dosage will necessarily occur depending on the condition of the subject being treated. The person responsible for administration will, in any event, determine the appropriate dose for the individual subject.
  • Targeting of ocular tissues may be accomplished in any one of a variety of ways.
  • the compound may be complexed with liposomes in the manner described above, and this compound/liposome complex injected into patients with AMD, using intravenous injection to direct the compound to the desired ocular tissue or cell.
  • Directly injecting the liposome complex into the proximity of the RPE or Bruch's membrane can also provide for targeting of the complex with some forms of AMD.
  • the compound is administered via intra-ocular sustained delivery (such as Vitrasert® or Envision® by Bauch and).
  • the compound is delivered by posterior subtenons injection.
  • microemulsion particles with apo E (such as, recombinant) are delivered to ocular tissue to take up lipid from Bruch's membrane, RPE cells, or both.
  • Human dosage amounts can initially be determined by extrapolating from the amount of compound used in mice, as a skilled artisan recognizes it is routine in the art to modify the dosage for humans compared to animal models.
  • the dosage may vary from between about 1 mg compound/Kg body weight to about 5000 mg compound/Kg body weight; or from about 5 mg/Kg body weight to about 4000 mg/Kg body weight or from about 10 mg/Kg body weight to about 3000 mg/Kg body weight; or from about 50 mg/Kg body weight to about 2000 mg/Kg body weight; or from about 100 mg/Kg body weight to about 1000 mg/Kg body weight; or from about 150 mg/Kg body weight to about 500 mg/Kg body weight.
  • this dose may be about 1, 5, 10, 25, 50, 75, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, 1000, 1050, 1100, 1150, 1200, 1250, 1300, 1350, 1400, 1450, 1500, 1600, 1700, 1800, 1900, 2000, 2500, 3000, 3500, 4000, 4500, 5000 mg/Kg body weight. In other embodiments, it is envisaged that higher does may be used, such doses may be in the range of about 5 mg compound/Kg body to about 20 mg compound/Kg body.
  • the doses may be about 8, 10, 12, 14, 16 or 18 mg/Kg body weight.
  • this dosage amount may be adjusted upward or downward, as is routinely done in such treatment protocols, depending on the results of the initial clinical trials and the needs of a particular patient.
  • kits may comprise a suitably aliquoted nuclear hormone receptor ligand, and/or additional agent compositions of the present invention, whether labeled or unlabeled, as may be used to prepare a standard curve for treatment of macular degeneration, such as AMD.
  • the components of the kits may be packaged in aqueous media or in lyophilized form.
  • the powder can be reconstituted by the addition of a suitable solvent. It is envisioned that the solvent may also be provided in another container means.
  • the container means of the kits will generally include at least one vial, test tube, flask, bottle, syringe or other container means, into which a component may be placed, and preferably, suitably aliquoted. Where there are more than one component in the kit, the kit also will generally contain a second, third or other additional container into which the additional components may be separately placed. However, various combinations of components may be comprised in a vial.
  • the kits of the present invention also will typically include a means for containing the nuclear hormone receptor ligand, additional agent, and any other reagent containers in close confinement for commercial sale. Such containers may include injection or blow-molded plastic containers into which the desired vials are retained.
  • Drug treatments were in serum free DMEM-H21 with or without 10 ⁇ 7 M thyroid hormone (T 3 ), 2.5 ⁇ 10 ⁇ 6 M 22 (R) hydroxycholesterol, or 10 ⁇ 7 M cis retinoic acid in both chambers for 36 hours.
  • RNAzol Tropon, Inc., Friendswood, Tex.
  • Equal amounts of purified RNA were used in each reaction as templates for cDNA synthesis using the 1st Strand Synthesis Kit for RT-PCR (AMV) (Boehringer, Indianapolis, Ind.).
  • RT-PCR was carried out on 1 ⁇ g of cDNA with Amplitaq Taq polymerase (Perkin-Elmer, Branchburg, N.J.).
  • apo E RT-PCR products were quantified using the QuantumRNA assay kit according to the manufacturer's instructions (Ambion, Austin, Tex.).
  • 18S rRNA and apo E cDNAs are simultaneously amplified in each reaction.
  • the RT-PCR products are resolved by electrophoresis on 1.4% agarose gels.
  • the apo E mRNA expression is assessed relative to the internal 18S rRNA expression by densitometric analysis of photographed agarose gels.
  • RT-PCR primers specific to human apo E, ABCA1, SR-BI, SR-BII, and 1xr a were used.
  • the RT-PCR product of the predicted sizes for the apo E, ABCA1, SR-BI, and SR-BII RT-PCR products were excised form the gel and their identities were confirmed by DNA sequencing (not shown).
  • RPE cells grown on slides, were ⁇ with either antisera to ABCA1, or with purified antibodies to SR-BI or SR-BII. Cells were fixed in ice cold 100% MeOH for 20 min. All subsequent steps were performed at room temperature. Cells were washed in phosphate buffered saline (PBS) and incubated for in 5% goat serum in PBS for 30 min. Cells were then washed in buffer A (150 mM NaCl, 10 mM phosphate, pH 7.8) and incubated with the primary antibody in buffer A for 45 min.
  • PBS phosphate buffered saline
  • the apo E containing bound fraction was eluted with 0.5M NaCl in Start buffer.
  • the eluate was concentrated to 20 ⁇ l and buffer-exchanged to SalEN by centrifugal ultrafiltration (Biomax, 5k MCO, Millipore, Bedford, Mass.).
  • Apo E was resolved by tris-tricine buffered SDS-PAGE (5-25% linear acrylamide gradient) and proteins electrophoetically transferred (55V, 18 h) to nitrocelluose membrane filters (Schleicher and Shuell, Keen, N H).
  • Membranes were blocked with 10% bovine serum albumin at room temperature and probed with 1% goat anti-human apo E antiserum (18 h, 3° C.) prepared in 0.15% NaCl, 1 mM EDTA (pH 7.4), 0.1% Triton X-100 (SalET).
  • the primary-bound anti-apo E antibodies were detected calorimetrically with horseradish peroxidase conjugated rabbit anti-goat Ig (H+L) and NiCl 2 -enhanced diaminobenzine staining. Stained bands were compared densitometrically from the digitized scanned image (NIH Image, v.1.62).
  • Anti apo E antibodies were obtained by hyper-immunization of goats with purified apo E or obtained from Assay Designs (A299, Ann Arbor, Mich.)
  • Lipoprotein fractions were prepared from conditioned media that was adjusted with solid KBr to a density of 1.21 g/ml. Samples were ultracentrifuged in a Beckman 42.2 Ti rotor at 40,000 rpm for 18 h at 110° C. The lipoprotein and lipoprotein-free fractions, the top and bottom 50 ⁇ l, respectively, were dialysed against SalEN prior to analysis.
  • Bovine outer photoreceptor outer segments were labeled by incubating for with Coenzyme A, ATP, Mg 2+ , and [ 14 C]-DHA.
  • Cells grown on laminin coated Transwell plates were incubated with 12 ⁇ g/ml labeled POS in the apical chamber for 36 hours in medium containing 10% lipoprotein deficient fetal bovine serum. The basal medium was subjected to scintillation counting to determine the amount of [ 14 C] labeled lipids transported through the RPE cells.
  • Bovine outer photoreceptor outer segments were labeled by incubating for with Coenzyme A, ATP, Mg 2+ , and [ 14 C]-DHA.
  • Cells grown on laminin coated Transwell plates were incubated with 12 ⁇ g/ml labeled POS in the apical chamber for 36 hours in medium containing 10% lipoprotein deficient fetal bovine serum.
  • the basal chambers contained either 1 mg/ml human HDL, 1 mg/ml human LDL or 100% human plasma.
  • TS-1 Research Products International
  • RPE cells express mRNAs for apo E, ABCA1, SR-BI, SR-BII and 1xr ⁇ . As shown in FIG. 1 lane 1, FIG. 1 lane 2 and FIG. 1 lane 3, RPE cells express mRNAs for apo E, ABCA1 and 1xr ⁇ , respectively.
  • RPE cells express mRNA for SR-BI and SR-BII respectively.
  • ABCA1 protein was demonstrated by immunofluorescent staining of RPE cells with an antibody to ABCA1 (FIG. 4). Cell nuclei were stained with DAPI.
  • RPE cells were cultured on laminin-coated Transwell plates. Specifically, human cultured RPE (passage 2-10, 35 y.o. donor) were placed on laminin-coated Transwell plates, wherein the upper and lower wells both had serum-free media. Total protein and apo E-specific protein concentrations were measured from media pooled and concentrated from 3-6 replicate wells. To assess apo E-specific secretion, apo E was purified from conditioned media by heparin-sepharose affinity chromatography and visualized by western blotting. Apo E concentrations were consistently greater in the basolateral media (FIG. 5, lane 1 vs. lane 2). These data demonstrate that RPE cells display polarized secretion of cellular proteins, including apo E. Thus, this indicated that Apo E is preferentially secreted basally, supporting its role in RCT.
  • RPE cells express 1xr ⁇ as well as thyroid hormone receptors (TRs) and retinoid-X-receptors (RXRs), the effect of 10 ⁇ 7 M T3, 2.5 ⁇ 10 ⁇ 6 M 22 (R) hydroxycholesterol (HC) (an 1xr ⁇ agonist), or 10 ⁇ 7 M cis retinoic acid (cRA) (an RXR agonist) on apo E secretion from RPE cells was tested.
  • TRs thyroid hormone receptors
  • RXRs retinoid-X-receptors
  • This example characterizes efflux of POS residues from RPE cells, particularly regarding binding to HDL.
  • Giusto et al. (1986) describes a method of 14 C decoshexanoic acid (DHA) labeling of bovine photoreceptor outer segment (POS) lipids.
  • DHA decoshexanoic acid
  • POS bovine photoreceptor outer segment
  • bovine photoreceptor outer segment are labeled with 14 C decoshexanoic acid (DHA) and placed in lipoprotein deficient media. Following this, they are placed over cultured human RPE on Transwell plates for 36 hours, and the basal medium contained either 100% plasma, HDL (1 mg/cc) or LDL (1 mg/cc). After 36 hours, basal media was centrifuged to collect lipoprotein fraction (density 1.2). This fraction was then run on a non-denaturing gel and stained with Coomassie blue.
  • FIG. 7 shows LDL and HDL fractions, both separately and together in plasma (PL). The PL fraction contains the same amount of HDL and LDL as each of the separated fractions (HDL, LDL).
  • the PA gel was cut into about 1 mm pieces, and the radioactivity distribution was determined (FIG. 8). With either LDL or HDL alone, counts were observed over respective lipoprotein fractions. When both LDL and HDL in plasma are present, counts localize preferentially over HDL fraction. This indicates that following phagocytosis of POS by RPE, POS residues are effluxed and preferentially bound by HDL. This is a novel demonstration illustrating that RCT to an HDL acceptor occurs in RPE cells.
  • a patient sample is obtained, such as by drawing blood, and the HDL is examined for bound POS residues. From this, a determination of their risk of visual loss from AMD is made.
  • the profile of bound POS residues is indicative of identifying an individual afflicted with ocular disease and/or of identifying an individual at risk for developing an ocular disease.
  • This experiment determines whether compound administration can upregulate efflux of labeled POS residues to HDL, particularly by showing regulation of 14 C-DHA labeled POS efflux into basal media.
  • An assay similar to that described in Example 4 is utilized; however, in this Example the cells were treated with T3, 9 cis-retinoic acid, and 22 (R) hydroxycholesterol in the concentrations described above for 36 hours.
  • Total radioactivity (cpm) in the absence of HDL purification was determined by liquid scintillation counting of the basal media.
  • FIG. 10 indicates that compound treatments increase RCT by cultured human RPE cells.
  • T3 The effect of T3 on Apo E mRNA levels was also assessed by RT-PCR. Treatment with 10 ⁇ 7 M T3 resulted in a 1.5 to 2-fold increase in apo E mRNA levels, suggesting that T3 is acting, at least in part, to increase apo E levels at the mRNA level.
  • administration of 9 cis-retinoic acid and 22 (R) hydroxycholesterol similarly upregulates expression of apo E.
  • RCT is regulated via nuclear hormone receptor ligands.
  • ABCA1 expression is upregulated by binding of LXR and RXR agonists to their respective nuclear hormone receptors (FIG. 11). Since these receptors form heterodimers bound to the ABCA1 promoter, ligand binding increases expression of ABCA1 and, hence, RCT.
  • Scavenger receptors in macrophages function to phagocytose oxLDL molecules.
  • SRs are types of SRs previously described in macrophages including SR-A1, SR-A2, SR-B1, SR-B2, CD36, and LOX.
  • SRs are distinct from LDL receptors in that levels of expression for SRs are upregulated by oxLDL. This upregulation by intracellular oxLDL levels is modulated by nuclear hormone receptors, peroxisome proliferator activated receptor (PPAR) and retinoic acid X receptor (RXR), that exert transcriptional control of CD36 expression.
  • PPAR peroxisome proliferator activated receptor
  • RXR retinoic acid X receptor
  • SR expression was studied in RPE cells. Expression of the following SRs in RPE cells was identified: CD36 (confirmation of previous investigators), SR-A1, SR-A2 (both first time demonstrated in RPE), SR-B1, SR-B2 (both first time demonstrated in RPE).
  • RPE cells express the nuclear hormone receptors, PPAR and RXR, indicating control mechanisms for SR expression are analogous between the cell types.
  • PPAR and RXR ligands e.g. PG-J2, thiazolidinediones, cis-retinoic acid. This controls the rate at which RPE cells phagocytose oxidized photoreceptor outer segments, and hence slows the rate at which abnormal lipid inclusions accumulate in RPE and BM.
  • expression of CD36 is downregulated with a composition such as tamoxifen, TGF-beta or INF-gamma.
  • a composition such as tamoxifen, TGF-beta or INF-gamma.
  • regulating expression of other RPE SRs would control levels of lipids in both RPE and BM.
  • IGF-1 TGF-beta, EGF, and/or PDGF
  • SR-B regulation cAMP and/or estradiol (for upregulation) or TNF-alpha, LPS, and/or INF-gamma (for downregulation) is used.
  • Mak P A Laffitte B A, Desrumaux C, Joseph S B, Curtiss L K, Mangelsdorf D J, Tontonoz P, Edwards P A: Regulated expression of the apolipoprotein E/C-I/C-IV/C-II gene cluster in murine and human macrophages. A critical role for nuclear liver X receptors alpha and beta. J Biol Chem. Aug. 30, 2002;277(35):31900-8

Abstract

The present invention addresses the treatment of age-related macular degeneration using regulation of pathogenic mechanisms similar to atherosclerosis. In further specific embodiments, reverse cholesterol transport components, such as transporters and HDL fractions, are utilized as diagnostic and therapeutic targets for age-related macular degeneration. In a specific embodiment, the lipid content of the retinal pigment epithelium, and/or Bruch's membrane is reduced.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • The present invention claims priority to U.S. Provisional Patent Application No. 60/340,498, filed Dec. 7, 2001 and U.S. Provisional Patent Application No. 60/415,864, filed Oct. 3, 2002, both of which are incorporated by reference herein in their entirety.[0001]
    • FIELD OF THE INVENTION
  • The present invention is directed to the fields of ophthalmology and cell biology. Specifically, the invention regards treatment of age-related macular degeneration (AMD) utilizing regulation of reverse cholesterol transport. [0002]
    • BACKGROUND OF THE INVENTION
  • Age-related macular degeneration (AMD) is the leading cause of severe visual loss in the developed world (Taylor et al., 2001; VanNewkirk et al., 2000). In the early stages of the disease, before visual loss occurs from choroidal neovascularization, there is progressive accumulation of lipids in Bruch's membrane (Pauleikhoff et al., 1990; Holz et al., 1994; Sheraidah et al., 1993; Spaide et al., 1999). Bruch's membrane lies at the critical juncture between the outer retina and its blood supply, the choriocapillaris. Lipid deposition causes reduced hydraulic conductivity and macromolecular permeability in Bruch's membrane and is thought to impair retinal metabolism (Moore et al., 1995; Pauleikhoff et al., 1990; Starita et al., 1996). Retina and/or RPE may respond by elaboration of angiogenic factors (e.g. VEGF, vFGF) that promote growth of choroidal neovascularization. [0003]
  • Interestingly, lipid accumulation in Bruch's membrane similar to that in AMD has been observed in apolipoprotein E (apo E) null mice (Dithmar et al., 2000; Kliffen et al., 2000). Because of the additional association between apo E alleles and other age-related degenerations, Alzheimer's disease and atherosclerosis, there has been recent investigation into a potential role for apo E in AMD. [0004]
  • Several studies on apo E polymorphism in AMD have been conducted (Simonelli et al., 2001; Klayer et al., 1998; Souied et al., 1998). In contrast to Alzheimer's disease, the apo E-4 allele has been associated with reduced prevalence of AMD. Apo E-2 allele is slightly increased in patients with AMD. Further supporting a role in AMD pathogenesis, apo E has been detected in drusen, the Bruch's membrane deposits that are the hallmark of AMD (Klayer et al., 1998; Anderson et al., 2001). Immunohistochemistry on post-mortem eyes has demonstrated apo E in the basal aspect of the retinal pigment epithelium (RPE) (Anderson et al., 2001). Cultured RPE cells synthesize high levels of apo E mRNA, comparable to levels found in brain (Anderson et al., 2001). [0005]
  • While the role of apo E in AMD is not established, this apolipoprotein has several functions that may affect the course of this disease. Apo E has anti-angiogenic (Browning et al., 1994), anti-inflammatory (Michael et al., 1994), and anti-oxidative effects (Tangirala et al., 2001). These are all considered atheroprotective attributes of Apo E, but may also be important in protecting against progression of AMD. While atheroprotective effects of apo E were initially thought to stem from effects on plasma lipid levels, local effects on vascular macrophages are probably equally important. Thus, selective enhanced expression of macrophage apo E in the arterial wall reduces atherosclerosis in spite of hyperlipidemia (Shimano et al., 1995; Bellosta et al., 1995; Hasty et al., 1999). Conversely, reconstitution of apo E null macrophages in C57BL/6 wild type mice induces atherosclerosis (Fazio et al., 1994). Atheroprotective effects of arterial apo E expression are thought to derive in part from facilitation of reverse cholesterol transport (Mazzone et al., 1992; Lin et al., 1999). The mechanisms by which apo E facilitates reverse cholesterol transport are incompletely understood. Apo E expression increases cholesterol efflux to HDL3 in J774 macrophages (Mazzone and Reardon, 1994) and lipid free apolipoprotein A1 (Langer et al., 2000). Cell surface apo E is also hypothesized to induce efflux from the plasma membrane (Lin et al., 1999). [0006]
  • Reverse cholesterol transport may be important in the pathogenesis of AMD because of lipid efflux from RPE into Bruch's membrane. Very much like intimal macrophages, RPE cells progressively accumulate lipid deposits throughout life; however, unlike vessel wall macrophages, the source of RPE lipid is thought to be retinal photoreceptor outer segments (POS) (Kennedy et al., 1995). Every day, each RPE cell phagocytoses and degrades more than one thousand POS via lyzosmal enzymes. These POS are enriched in phospholipid and contain the photoreactive pigment, rhodopsin. Incompletely digested POS accumulate as lipofuscin in RPE. By age 80, approximately 20% of RPE cell volume is occupied by lipofuscin (Feeney-Burns et al., 1984). [0007]
  • Analysis of Bruch's membrane lipid reveals an age-related accumulation of phospholipid, triglyceride, cholesterol, and cholesterol ester (Holz et al., 1994; Curcio et al., 2001). The origin of these lipids also is thought to derive principally from POS rather than from the circulation (Holz et al., 1994; Spaide et al., 1999). POS lipids are hypothesized to efflux from the RPE into Bruch's membrane. Although cholesterol ester deposition in Bruch's suggests contribution from plasma lipids, biochemical analysis of these esters suggests esterification of intracellular cholesterol by RPE cell derived ACAT (Curcio et al., 2002). While trafficking of lipids from the retina to RPE cells has been studied extensively, mechanisms of lipid efflux from RPE to Bruch's membrane are not well understood. Furthermore, from a pathogenic standpoint, regulation of lipid efflux into Bruch's membrane may be important in determining the rate of lipid-induced thickening that occurs in aging. [0008]
  • Nuclear hormone receptor ligands regulate reverse cholesterol transport in macrophages via their effects on ABCA-1 and apo E expression. Liver X receptor (LXR) and/or retinoid X receptor (RXR) ligands increase levels of these transporters and increase reverse cholesterol transport in macrophages (Mak et al., 2002; Laffitte et al., 2001). Thyroid hormone has also been demonstrated to increase expression of apo E three fold in HepG2 cells (Laffitte et al., 1994). [0009]
  • In AS, similar to AMD, lipids accumulate in the extracellular matrix and within phagocytic cells, primarily macrophages. Mechanisms of lipid metabolism in AS have been investigated in detail. Similar investigations into lipid processing by RPE and subsequent lipid efflux into BM and the circulation have not been conducted with the same depth as those for AS. As a consequence, potential therapeutic approaches to dry AMD are wonting. [0010]
  • Mullins et al. (2000) describe compositional similarity between drusen and other extracellular deposits, including atherosclerotic plaques. Specifically, vitronectin, amyloid P, Apo E, and lipids are among the constituents shared in common. More specifically, apolipoprotein E is identified in retinal pigmented epithelium. [0011]
  • Friedman (2000) reviews the role of atherosclerosis in the pathogenesis of AMD. Specifically, the review mentions targeting the angiogenesis pathway for treating the neovascular form of AMD, such as the member VEGF. It is noted that interfering with the upregulation or action of angiogenic agents may prove helpful for choroidal neovascularization, and, in alternative embodiments, statins may be useful for lowering the risk of AMD. [0012]
  • Anderson et al. (2001) reports apolipoprotein E protein is found in the same location as drusen, likely originating from the retinal pigmented epithelium. [0013]
  • U.S. Pat. No. 6,071,924 regards inhibition of proliferation of retinal pigment epithelium by contacting RPE cells with a retinoic acid receptor agonist, except for retinoic acid, preferably thereby inhibiting AP-1-dependent gene expression. In specific embodiments, an AP1 antagonist is delivered to a subject in need thereof for inhibition of proliferation of retinal pigment epithelium or a disease associated therewith. The related U.S. Pat. No. 6,075,032 is directed to inhibition of choroidal neovascularization by contacting RPE cells with an AP-1 antagonist. The related U.S. Pat. No. 5,824,685 regards amelioration of proliferative vitreoretinopathy or traction retinal detachment by contacting RPE cells with a retinoic acid receptor selected from ethyl-6-[2-(4,4-dimethylthiochroman-6-yl)ethynyl]nicotinate, 6-[2-(4,4-dimethylchroman-6-yl)ethynyl]nicotinic acid, and p-[(E)-2-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthyl)propenyl]-benzoic acid. The related U.S. Pat. No. 6,372,753 addresses inhibition of an ocular disease resulting from proliferation of retinal pigment epithelium by providing at least one AP-1 antagonist and at least one retinoic acid receptor (RAR) agonist, except for retinoic acid. [0014]
  • WO 01/58494 is directed to treating or preventing an ocular disease, such as age-related macular degeneration, by contacting an ocular cell with an expression vector comprising a nucleic acid sequence encoding an inhibitor of angiogenesis and a neurotrophic agent. In specific embodiments, the inhibitor of angiogenesis and the neurotrophic agent are one and the same, such as pigment epithelium-derived factor (PEDF). [0015]
  • WO 02/13812 regards the use of an insulin-sensitizing agent, preferably peroxisome proliferator-activated receptor-γ (PPAR γ) agonists, for the treatment of an inflammatory disease, such as an ophthalmic disease. [0016]
  • WO 00/52479 addresses diagnosing, treating, and preventing drusen-associated disorders (any disorder which involves drusen formation), including AMD. In specific embodiments, there are methods related to providing an effective amount of an agent that inhibits immune cell proliferation or differentiation, such as antagonists of TNF-alpha. [0017]
  • Thus, the present invention provides a novel approach to reduce lipid content of ocular tissue, such as Bruch's membrane and further provides methods and compositions for the treatment of macular degeneration, such as AMD. [0018]
    • BRIEF SUMMARY OF THE INVENTION
  • The present invention is directed to a system, method, and/or composition(s) related to treating AMD. Treatments for dry AMD have been lacking, because the pathogenesis of this common condition is poorly understood, and the inventors have demonstrated analogous biological behavior between human retinal pigment epithelial (RPE) cells and macrophages that point toward similar pathogenic mechanisms of AMD and atherosclerosis. Specifically, reverse cholesterol transport (RCT) is exploited in the present invention for the treatment of AMD. The present inventors provide the novel demonstration of RCT in RPE cells in the eye. More specifically, RCT is regulated through manipulation of levels of cholesterol and/or phospholipid transporters (ABCA-1, Apo E, SRB-1, SRB-2) by nuclear hormone receptor ligands such as agonists of thyroid hormone (TR), liver X receptor (LXR), and/or retinoid X receptor (RXR). A goal for the present invention is the reduction of lipid content of RPE Bruch's membrane to facilitate an improvement in visual function and/or, in some embodiments, prevent ocular disease, such as AMD. Reduction of the lipid content of Bruch's membrane preferably results in at least one or more of the following: reduction in development of CNV; improvement in dark adaptation; improvement in night vision; improved visual acuity; and/or improved recovery to bright flash stimulus. [0019]
  • In a specific embodiment of the present invention, patients with drusen and no evidence of choroidal neovascularization are administered a nuclear hormone agonist, such as thyroid hormone (TR) agonist (for example, T3 (3,5,3′-L-triiodothyronine), TRIAC (3-triiodothyoacetic acid), GC1, KB-000,141 and/or KB141 (Karo Bio; Huddinge, Sweden). Administration could be orally or by sustained release systems well known in the art. In a specific embodiment, the agonist binds to at least one nuclear hormone receptor in the RPE and induces upregulation of RCT. Efflux of lipid from RPE increases, and the likelihood of visual loss from choroidal neovascularization is reduced. Other nuclear hormone receptor ligands of the TR, RXR, and LXR families, for example, which are well known in the art, are used independently or in combination with each other to enhance RCT by RPE. [0020]
  • In an embodiment of the present invention, there is a method of increasing lipid efflux from an ocular tissue, comprising the step of delivering to the tissue a nuclear hormone receptor ligand. In a specific embodiment, ocular tissue is retinal pigment epithelium (RPE), Bruch's membrane, or a combination thereof. In another specific embodiment, the nuclear hormone receptor is thyroid hormone receptor. In an additional specific embodiment, the ligand of thyroid hormone receptor is 3,5,3′-L-triiodothyronine (T3), TRIAC (3-triiodothyroacetic acid); KB141; GC-1; 3, 5 dimethyl-3-isopropylthyronine; or a mixture thereof. In one embodiment, the nuclear hormone receptor is liver X receptor. In a specific embodiment, the ligand of liver X receptor is 22 (R) hydroxycholesterol; acetyl-podocarpic dimer; T0901317; GW3965 (12); 24(S),25-epoxycholesterol; 24(R),25-epoxycholesterol; 22(R)-ol-24(S),25-epoxycholesterol; 22(S)-ol,24(R),25-epoxycholesterol; 24(S),25-iminocholesterol; methyl-H-cholenate; dimethyl-hydroxycholenamide; 24(S)-hydroxycholesterol; 24(R)-hydroxycholesterol; 22(S)-hydroxycholesterol; 22(R),24(S)-dihydroxycholesterol; 25-hydroxycholesterol; 24(S),25-dihydroxycholesterol; 24(R),25-dihydroxycholesterol; 24,25-dehydrocholesterol; 7(a)-ol,24(S),25-epoxycholesterol; 7(b)-ol,24(S),25-epoxycholesterol; 7k,24(S),25-epoxycholesterol; 7(α)-hydroxycholesterol; 7-ketocholesterol; cholesterol; 5,6-24(S),25-diepoxycholesterol; or a mixture thereof. In a specific embodiment, the nuclear hormone receptor is retinoid X receptor, ligands of which include 9 cis-retinoic acid; AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid]; AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid]; AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-tetrahydronaphthalen-2-yl) (5 carboxypyrid-2-yl)sulfide]; LGD346; LG100268; LG100754; BMS649; bexaroteneR (4-[1-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl) ethenyl] benzoic acid); or a mixture thereof. In one embodiment, the ocular tissue is comprised in an individual, such as one at risk for developing macular degeneration or another ocular disease, and/or the ocular tissue is comprised in individuals afflicted with macular degeneration (for example, age-related macular degeneration). In other specific embodiment, the individual is afflicted with Stargardts disease (fundus flavimaculatus) or is at risk for developing Stargardts disease. [0021]
  • In another embodiment of the present invention, there is a method of increasing reverse cholesterol transport in an ocular tissue, comprising the step of delivering to the tissue at least one ligand of a nuclear hormone receptor. In a specific embodiment, the ocular tissue is retinal pigment epithelium (RPE), Bruch's membrane, or a combination thereof. [0022]
  • In an additional embodiment of the present invention, there is a method of treating macular degeneration (AMD) in an individual, comprising the step of delivering to the individual a ligand of a nuclear hormone receptor. In a specific embodiment, the delivering occurs under conditions wherein reverse cholesterol transport is upregulated. [0023]
  • In another embodiment of the present invention, there is a kit for the treatment of macular degeneration, housed in a suitable container, comprising a ligand of a nuclear hormone receptor. In a specific embodiment, the nuclear hormone receptor is TR, RXR, LXR, or a combination thereof. In some embodiments, it is useful to comprise a combination of nuclear hormone receptors, since it is well known in the art that many are heterodimers (for example, LXR and RXR, or RXR and TR). In a specific embodiment, the kit comprises a pharmaceutically acceptable excipient. In another specific embodiment, the ligand for a nuclear hormone receptor is comprised in the pharmaceutically acceptable excipient. [0024]
  • In an additional embodiment of the present invention, there is a method of treating macular degeneration (AMD) in an individual, comprising the steps of identifying a ligand for a nuclear hormone receptor; and delivering said ligand to said individual. Methods to identify a ligand for a nuclear hormone receptor are well known in the art. [0025]
  • The foregoing has outlined rather broadly the features and technical advantages of the present invention in order that the detailed description of the invention that follows may be better understood. Additional features and advantages of the invention will be described hereinafter which form the subject of the claims of the invention. It should be appreciated by those skilled in the art that the conception and specific embodiment disclosed may be readily utilized as a basis for modifying or designing other structures for carrying out the same purposes of the present invention. It should also be realized by those skilled in the art that such equivalent constructions do not depart from the spirit and scope of the invention as set forth in the appended claims. The novel features which are believed to be characteristic of the invention, both as to its organization and method of operation, together with further objects and advantages will be better understood from the following description when considered in connection with the accompanying figures. It is to be expressly understood, however, that each of the figures is provided for the purpose of illustration and description only and is not intended as a definition of the limits of the present invention.[0026]
    • BRIEF DESCRIPTION OF THE DRAWINGS
  • For a more complete understanding of the present invention, reference is now made to the following descriptions taken in conjunction with the accompanying drawing, in which: [0027]
  • FIG. 1 shows that RPE cells express Apo E, ABCA1, and LXR α. [0028]
  • FIG. 2 shows RPE cell expression of SR-BI and SR-BII. [0029]
  • FIG. 3 illustrates SR-BI and SR-BII immunofluorescence in RPE cells. [0030]
  • FIG. 4 demonstrates ABCA1 immunofluorescence in RPE cells. [0031]
  • FIG. 5 demonstrates that basal Apo E expression is greater than apical Apo E expression in cultured human RPE cells. [0032]
  • FIG. 6 shows regulation of Apo E expression by nuclear hormone receptor ligands. [0033]
  • FIG. 7 provides a non-denatured polyacrylamide gel of lipoprotein fractions. [0034]
  • FIG. 8 shows [0035] 14C distributeion of the fractions from FIG. 7.
  • FIG. 9 demonstrates thin layer chromatography illustrating the identification of six out of seventeen spots of an HDL fraction. Note: HDL is the high density lipoprotein fraction; POS is labeled POS starting material; PC is phophatidylcholine; PI is phosphatidylinisotol; PE is phosphatidylethanolamine; C is cholesterol; TRL is TG rich lipid, including triglycerides and cholesterol ester. [0036]
  • FIG. 10 demonstrates that [0037] 14C counts increase following drug treatments that increase RCT.
  • FIG. 11 illustrates ABCA1 regulation by RXR and LXR ligands. [0038]
  • FIG. 12 shows HDL, LDL and plasma stimulation of [0039] 14C-labeled lipid transport the identification of HDL from RPE cells.
  • FIG. 13 shows stimulation of CD36 expression by oxidized lipid.[0040]
    • DETAILED DESCRIPTION OF THE INVENTION
  • I. Definitions [0041]
  • As used herein the specification, “a” or “an” may mean one or more. As used herein in the claim(s), when used in conjunction with the word “comprising”, the words “a” or “an” may mean one or more than one. As used herein “another” may mean at least a second or more. [0042]
  • The term “age-related macular degeneration” as used herein refers to macular degeneration in an individual over the age of about 50. In one specific embodiment, it is associated with destruction and loss of the photoreceptors in the macula region of the retina resulting in decreased central vision and, in advanced cases, legal blindness. [0043]
  • The term “Bruch's membrane” as used herein refers to a five-layered structure separating the choriocapillaris from the RPE. [0044]
  • The term “increase lipid efflux” or “increasing lipid efflux” as used herein refers to an increased level and/or rate of lipid efflux, promoting lipid efflux, enhancing lipid efflux, facilitating lipid efflux, upregulating lipid efflux, improving lipid efflux, and/or augmenting lipid efflux. In a specific embodiment, the efflux comprises efflux of phospholipid, triglyceride, cholesterol, and/or cholesterol ester. [0045]
  • The term “macula” as used herein refers to the light-sensing cells of the central region of the retina. [0046]
  • The term “macular degeneration” as used herein refers to deterioration of the central portion of the retina, the macula. [0047]
  • The term “nuclear hormone receptor” as used herein refers to an intracellular receptor that plays a role in expression of gene(s) involved in physiological processes, examples of which include cell growth and differentiation, development, and homeostasis. In a specific embodiment, these receptors are members of a superfamily of receptors, whose members recognize similar DNA sequences that contain two or more hexanucleotide DNA-binding half-sites arranged as direct repeats or inverted repeats. It is through this recognition that these receptors are able to regulate the expression of genes in the nucleus, and thereby regulate the respective physiological process. Examples of nuclear hormone receptors include thyroid hormone receptor, liver X receptor, retinoid X receptor, estrogen receptor, androgen receptor, peroxisome proliferator activated receptors (PPARs), trans-retinoic acid receptor (RAR), the vitamin D receptor (VDR), glucocorticoid receptor, the progesterone receptor, and isoforms thereof. [0048]
  • Nuclear hormone receptors in some embodiments include those that remain sequestered in the cytoplasm in the absence of their cognate ligands (e.g., steroid hormone receptors). Upon binding of the ligand, the steroid hormone receptors are translocated to the nucleus where they bind to hormone response elements, typically as homodimers. [0049]
  • In other embodiments the nuclear hormone receptors are not sequestered in the cytoplasm in the absence of their ligands, but rather remain in the nucleus. These receptors, which include the thyroid hormone, retinoid, fatty acid, and eicosanoid receptors, typically bind to their cognate response elements as heterodimers with, for example, a 9-cis-retinoic acid receptor (RXR). Often, binding of a nuclear receptor to a response element occurs in the absence of the cognate ligand. An example of such a nuclear receptor is the famesoid X receptor (FXR). [0050]
  • Methods to identify ligands of nuclear hormone receptors are well known in the art, examples of which are described in U.S. Pat. No. 5,846,711 and U.S. Pat. No. 6,266,622, both of which are incorporated by reference herein in their entirety. [0051]
  • The term “reverse cholesterol transport” as used herein refers to transport of cholesterol from peripheral tissues to the liver. In a specific embodiment, it refers to efflux of lipid from RPE cells. In specific embodiments, it comprises efflux of cellular cholesterol and/or phospholipid to HDL, and, in further specific embodiments, it comprises HDL delivery of cholesterol ester to the liver, such as for biliary secretion. [0052]
  • The term “upregulate” as used herein is defined as increasing the level and/or rate of an event, process, or mechanism, such as reverse cholesterol transport. [0053]
  • II. The Present Invention [0054]
  • As stated, the histopathology of macula in patients with AMD shows diffuse thickening of Bruch's membrane, and the overlying RPE is attenuated and full of lipofuscin granules. Photoreceptors are shortened and atrophic, and much of the thickened Bruch's membrane consists of lipid deposition. It is known that following about 50 years of age, the rate of lipid accumulation accelerates (Holz et al., 1994). [0055]
  • Using cell culture methods to study lipid metabolism, the inventors have, shown a number of analogous mechanisms for lipid metabolism that are shared by macrophages and human RPE cells. The shared biology of these two cell types indicates useful therapeutic approaches for treatment of AMD. Specifically, the present inventors are the first to show that RCT occurs in RPE cells, and enhancement of RCT is beneficial for removing undesired lipid from the RPE cells and/or Bruch's membrane to facilitate retinal metabolism. In a specific embodiment, the transporters in the RCT system are regulated to improve RCT. In a further specific embodiment, this regulatory aspect of the present invention provides a novel treatment for AMD. [0056]
  • Although there has been discussion in the field regarding mechanisms of lipid accumulation in macula of AMD individuals, the present invention regards efflux of lipid into the circulation, which reduces the amount of lipid in RPE and/or Bruch's membrane. Promotion of this efflux comprises one aspect of the invention and is an effective therapy for both early and late AMD. A skilled artisan recgonizes that early AMD comprises the presence of drusen and late stage AMD comprises visual loss from choroidal neovascularization or geographic atrophy. [0057]
  • Thus, the present invention provides the novel idea in the field in which reverse cholesterol transport occurs in RPE cells. In specific embodiments, the invention provides methods and compositions related to facilitating efflux of cholesterol and/or phospholipids from inside an RPE cell to the outside of the RPE cell, and further through Bruch's membrane. In another specific embodiment, following efflux from Bruch's membrane the cholesterol and/or phospholipids are transported by apolipoprotein E, apolipoprotein A1, and other transporters, or a combination thereof, to HDL for removal to the liver. [0058]
  • A skilled artisan recognizes the important role reverse cholesterol transport (RCT) plays in lipid homeostasis. HDL levels are inversely correlated with incidence of coronary artery disease (CAD). Tangier's disease, which comprises a mutation of ABCA1, leads to deposition of cholesterol in reticuloendothelial tissues and premature atherosclerosis. Furthermore, the Apo E null mouse is an excellent model of atherosclerosis and hyperlipidemia. Interestingly, supporting an important role of Apo E in RCT, reconstitution of Apo E positive macrophages via bone marrow transplant into an Apo E null mouse prevents atherosclerosis. This occurs in spite of persistent hyperlipidemia. [0059]
  • In one embodiment of the present invention a transporter of lipid from RPE cells is enhanced for the transport activity, such as by an increase in the level of the transporter. Examples of transporters include apo E, ABCA1, SR-BI, SR-BII, ABCA4, ABCG5, ABCG8; other proteins that might be involved are LCAT, CETP, PLTP, LRP receptor, LDL receptor, Lox-1, and lipases. In a specific embodiment, lox-1 and PLTP are expressed in RPE, as demonstrated by RT_PCR. In a specific embodiment of the present invention, apo A1 is utilized to facilitate RCT from RPE cells. In an additional specific embodiment, apo A1 is made by RPE cells. [0060]
  • In a specific embodiment of the present invention, strategies for intervention for treatment of AMD are provided in which reverse cholesterol transport is enhanced at the level of the RPE by upregulating ABCA1, Apo E, SR-BI and/or SR-BII expression. SR-B has been reported to be upregulated by 17beta-Estradiol and testosterone. Additionally, or alone, HDL binding to effluxed lipids is enhanced, thereby increasing efflux of lipids from Bruch's membrane into the circulation and providing therapy for AMD. In one embodiment, an increase in HDL levels is utilized to facilitate lipid efflux from RPE cells and/or Bruch's membrane, and in a specific embodiment, levels of specific subspecies of HDL are utilized to facilitate lipid efflux. For example, effluxed lipids could bind to preβ-HDL, HDL1, HDL2 or HDL3. Effluxed lipids could also bind prebeta-1, prebeta-2, prebeta-3, and/or prebeta-4 HDL. In a specific embodiment, the effluxed lipids bind preferentially to HDL2 that comprises apo E. [0061]
  • One skilled in the art recognizes particular RCT components are present in RPE cells (Mullins et al., 2000; Anderson et al., 2001). Nuclear hormone receptors known to regulate expression of reverse cholesterol transport proteins are also expressed in cultured human RPE. Thus, in a preferred embodiment of the present invention, ligands to at least one of the nuclear hormone receptors upregulates RCT. In further embodiments, following efflux from RPE cells, the lipids bind HDL, so in an embodiment of the present invention there is upregulation of HDL for AMD treatment, such as by statins and/or niacin. [0062]
  • In an alternative embodiment, treatment for AMD comprises reduction of RCT. For example, in individuals past a certain age, such as about 50, 55, 60, 65, 70, 75, 80, and so on, the transporters are preferentially inhibited. In one aspect of this embodiment, HDL is unable to enter Bruch's membrane to remove the lipids and the RPE continues to efflux lipids. In such cases where effluxed lipids from RPE cannot be removed by a lipoprotein acceptor, lipid efflux by RPE is inhibited to maintain macromolecular transport across Bruch's membrane. Inhibition of RCT by reducing levels of ABCA-1, apo E, and/or SRB-1, or SRB-2 would reduce accumulation of lipid in Bruch's membrane. [0063]
  • In embodiments of the present invention, ligands for nuclear hormone receptors are utilized as compounds for enhancing RCT for the reduction of lipid content of RPE and Bruch's membrane. In a specific embodiment, the nuclear hormone receptor ligands are utilized for treatment of AMD. In a further specific embodiment, the nuclear hormone receptors comprise TR, RXR, and/or LXR. In other specific embodiments, ligands of the nuclear hormone receptors are delivered to at least one RPE cell to facilitate efflux of lipids from the RPE cell and/or are delivered to Bruch's membrane for efflux from Bruch's membrane. Examples of ligands for TR include T3 (3,5,3′-L-triiodothyronine). Other examples of TR ligands include but are not limited to TRIAC (3-triiodothyroacetic acid); KB141 (Karo Bio); GC-1; and 3, 5 dimethyl-3-isopropylthyronine. Examples of ligands for RXR include 9 cis-retinoic acid, and other RXR ligands also include but are not limited to: AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid]; AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid]; AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-tetrahydronaphthalen-2-yl) (5 carboxypyrid-2-yl)sulfide]; LGD346; LG100268; LG100754; BMS649; and bexaroteneR (Ligand Pharmaceuticals) (4-[1-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl) ethenyl] benzoic acid). Examples of ligands for LXR include 22 (R) hydroxycholesterol, acetyl-podocarpic dimer, T0901317, and GW3965. [0064]
  • In an embodiment of the present invention, expression of a sequence is monitored following administration of an upregulator of its expression or a compound suspected to be an upregulator. A skilled artisan recognizes how to obtain these sequences, such as commercially from Celera Genomics, Inc. (Rockville, Md.) or from the National Center for Biotechnology Information's GenBank database. Exemplary apo E polynucleotide sequences include the following, cited with their GenBank Accession number: SEQ ID NO:1 (K00396); SEQ ID NO:2 (M10065); and SEQ ID NO:3 (M12529). Some exemplary apo E polypeptide sequences include the following, cited with their GenBank Accession number: SEQ ID NO:4 (AAB59546); SEQ ID NO:5 (AAB59397); and SEQ ID NO:6 (AAB59518). [0065]
  • In other embodiments, sequences of ABCA-[0066] 1 are utilized, such as to monitor ABCA-1 expression related to methods of the present invention. Some examples of ABCA1 polynucleotides include SEQ ID NO:7 (NM—005502); and SEQ ID NO:8 (AB055982). Some examples of ABCA1 polypeptides include SEQ ID NO:9 (NP—005493); and SEQ ID NO:10 (BAB63210).
  • In some methods of the present invention, expression levels of sequences of SR-BI and SR-B2 polynucleotides are monitored following administration of a nuclear hormone receptor ligand. An example of SR-BI polynucleotide is SEQ ID NO:11 (NM[0067] —005505) and an example of a SR-BI polypeptide is SEQ ID NO:12 (NP—005496).
  • III. Pharmaceutical Compositions and Routes of Administration [0068]
  • Compositions of the present invention may have an effective amount of a compound for therapeutic administration and, in some embodiments, in combination with an effective amount of a second compound that is also an anti-AMD agent. In a specific embodiment, the compound is a ligand/agonist of a nuclear hormone receptor. In other embodiments, compounds that upregulate expression of HDL are the compounds for therapeutic administration. Such compositions will generally be dissolved or dispersed in a pharmaceutically acceptable carrier or aqueous medium. [0069]
  • The phrases “pharmaceutically or pharmacologically acceptable” refer to molecular entities and compositions that do not produce an adverse, allergic or other untoward reaction when administered to an animal, or human, as appropriate. As used herein, “pharmaceutically acceptable carrier” includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents and the like. The use of such media and agents for pharmaceutical active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredients, its use in the therapeutic compositions is contemplated. Supplementary active ingredients, such as other anti-AMD agents, can also be incorporated into the compositions. [0070]
  • In addition to the compounds formulated for parenteral administration, such as intravenous or intramuscular injection, other pharmaceutically acceptable forms include, e.g., tablets or other solids for oral administration; time release capsules; and any other form currently used, including cremes, lotions, mouthwashes, inhalants and the like. [0071]
  • The delivery vehicles of the present invention may include classic pharmaceutical preparations. Administration of these compositions according to the present invention will be via any common route so long as the target ocular tissue is available via that route. This includes oral, nasal, buccal, rectal, vaginal or topical. Alternatively, administration may be by orthotopic, intradermal, subcutaneous, intramuscular, intraperitoneal or intravenous injection. Such compositions would normally be administered as pharmaceutically acceptable compositions. In some embodiments, the compositions are administered by sustained release intra- or extra-ocular devices. [0072]
  • The vehicles and therapeutic compounds therein of the present invention are advantageously administered in the form of injectable compositions either as liquid solutions or suspensions; solid forms suitable for solution in, or suspension in, liquid prior to injection also may be prepared. These preparations also may be emulsified. A typical composition for such purposes comprises a 50 mg or up to about 100 mg of human serum albumin per milliliter of phosphate buffered saline. Other pharmaceutically acceptable carriers include aqueous solutions, non-toxic excipients, including salts, preservatives, buffers and the like. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oil and injectable organic esters, such as theyloleate. Aqueous carriers include water, alcoholic/aqueous solutions, saline solutions, parenteral vehicles such as sodium chloride, Ringer's dextrose, etc. Intravenous vehicles include fluid and nutrient replenishers. Preservatives include antimicrobial agents, anti-oxidants, chelating agents and inert gases. The pH and exact concentration of the various components in the pharmaceutical are adjusted according to well-known parameters. [0073]
  • Additional formulations are suitable for oral administration. Oral formulations include such typical excipients as, for example, pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharine, cellulose, magnesium carbonate and the like. The compositions take the form of solutions, suspensions, tablets, pills, capsules, sustained release formulations or powders. When the route is topical, the form may be a cream, ointment, salve or spray. [0074]
  • An effective amount of the therapeutic agent is determined based on the intended goal. The term “unit dose” refers to a physically discrete unit suitable for use in a subject, each unit containing a predetermined quantity of the therapeutic composition calculated to produce the desired response in association with its administration, i.e., the appropriate route and treatment regimen. The quantity to be administered, both according to number of treatments and unit dose, depends on the subject to be treated, the state of the subject and the protection desired. Precise amounts of the therapeutic composition also depend on the judgment of the practitioner and are peculiar to each individual. [0075]
  • All of the essential materials and reagents required for AMD treatment, diagnosis and/or prevention may be assembled together in a kit. When the components of the kit are provided in one or more liquid solutions, the liquid solution preferably is an aqueous solution, with a sterile aqueous solution being particularly preferred. [0076]
  • For in vivo use, an anti-AMD agent may be formulated into a single or separate pharmaceutically acceptable syringeable composition. In this case, the container means may itself be an inhalant, syringe, pipette, eye dropper, or other such like apparatus, from which the formulation may be applied to an infected area of the body, such as the lungs, injected into an animal, or even applied to and mixed with the other components of the kit. [0077]
  • The components of the kit may also be provided in dried or lyophilized forms. When reagents or components are provided as a dried form, reconstitution generally is by the addition of a suitable solvent. It is envisioned that the solvent also may be provided in another container means. The kits of the invention may also include an instruction sheet defining administration of the anti-AMD composition. [0078]
  • The kits of the present invention also will typically include a means for containing the vials in close confinement for commercial sale such as, e.g., injection or blow-molded plastic containers into which the desired vials are retained. Irrespective of the number or type of containers, the kits of the invention also may comprise, or be packaged with, an instrument for assisting with the injection/administration or placement of the ultimate complex composition within the body of an animal. Such an instrument may be an inhalant, syringe, pipette, forceps, measured spoon, eye dropper or any such medically approved delivery vehicle. [0079]
  • The active compounds of the present invention will often be formulated for parenteral administration, e.g., formulated for injection via the intravenous, intramuscular, subcutaneous, or even intraperitoneal routes. The preparation of an aqueous composition that contains a second agent(s) as active ingredients will be known to those of skill in the art in light of the present disclosure. Typically, such compositions can be prepared as injectables, either as liquid solutions or suspensions; solid forms suitable for using to prepare solutions or suspensions upon the addition of a liquid prior to injection can also be prepared; and the preparations can also be emulsified. [0080]
  • Solutions of the active compounds as free base or pharmacologically acceptable salts can be prepared in water suitably mixed with a surfactant, such as hydroxypropylcellulose. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, and mixtures thereof and in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms. [0081]
  • The pharmaceutical forms suitable for injectable use include sterile aqueous solutions or dispersions; formulations including sesame oil, peanut oil or aqueous propylene glycol; and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In all cases the form must be sterile and must be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms, such as bacteria and fungi. [0082]
  • The active compounds may be formulated into a composition in a neutral or salt form. Pharmaceutically acceptable salts, include the acid addition salts (formed with the free amino groups of the protein) and which are formed with inorganic acids such as, for example, hydrochloric or phosphoric acids, or such organic acids as acetic, oxalic, tartaric, mandelic, and the like. Salts formed with the free carboxyl groups can also be derived from inorganic bases such as, for example, sodium, potassium, ammonium, calcium, or ferric hydroxides, and such organic bases as isopropylamine, trimethylamine, histidine, procaine and the like. [0083]
  • The carrier can also be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), suitable mixtures thereof, and vegetable oils. The proper fluidity can be maintained, for example, by the use of a coating, such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants. The prevention of the action of microorganisms can be brought about by various antibacterial and/or antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin. [0084]
  • Sterile injectable solutions are prepared by incorporating the active compounds in the required amount in the appropriate solvent with various of the other ingredients enumerated above, as required, followed by filtered sterilization. Generally, dispersions are prepared by incorporating the various sterilized active ingredients into a sterile vehicle which contains the basic dispersion medium and the required other ingredients from those enumerated above. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum-drying and freeze-drying techniques which yield a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof. [0085]
  • In certain cases, the therapeutic formulations of the invention could also be prepared in forms suitable for topical administration, such as in eye drops, cremes and lotions. [0086]
  • Upon formulation, solutions will be administered in a manner compatible with the dosage formulation and in such amount as is therapeutically effective. The formulations are easily administered in a variety of dosage forms, such as the type of injectable solutions described above, with even drug release capsules and the like being employable. [0087]
  • For parenteral administration in an aqueous solution, for example, the solution should be suitably buffered if necessary and the liquid diluent first rendered isotonic with sufficient saline or glucose. These particular aqueous solutions are especially suitable for intraocular, intravenous, intramuscular, and subcutaneous administration. In this connection, sterile aqueous media that can be employed will be known to those of skill in the art in light of the present disclosure. For example, one dosage could be dissolved in 1 mL of isotonic NaCl solution and either added to 1000 mL of hypodermoclysis fluid or injected at the proposed site of infusion, (see for example, “Remington's Pharmaceutical Sciences” 15th Edition, pages 1035-1038 and 1570-1580). Some variation in dosage will necessarily occur depending on the condition of the subject being treated. The person responsible for administration will, in any event, determine the appropriate dose for the individual subject. [0088]
  • Targeting of ocular tissues may be accomplished in any one of a variety of ways. In one embodiment, there is the use of liposomes to target a compound of the present invention to the eye, and preferably to RPE cells and/or Bruch's membrane. For example, the compound may be complexed with liposomes in the manner described above, and this compound/liposome complex injected into patients with AMD, using intravenous injection to direct the compound to the desired ocular tissue or cell. Directly injecting the liposome complex into the proximity of the RPE or Bruch's membrane can also provide for targeting of the complex with some forms of AMD. In a specific embodiment, the compound is administered via intra-ocular sustained delivery (such as Vitrasert® or Envision® by Bauch and). In a specific embodiment, the compound is delivered by posterior subtenons injection. In another specific embodiment, microemulsion particles with apo E (such as, recombinant) are delivered to ocular tissue to take up lipid from Bruch's membrane, RPE cells, or both. [0089]
  • Those of skill in the art will recognize that the best treatment regimens for using compounds of the present invention to treat AMD can be straightforwardly determined. This is not a question of experimentation, but rather one of optimization, which is routinely conducted in the medical arts. In vivo studies in nude mice often provide a starting point from which to begin to optimize the dosage and delivery regimes. The frequency of injection will initially be once a week, as has been done in some mice studies. However, this frequency might be optimally adjusted from one day to every two weeks to monthly, depending upon the results obtained from the initial clinical trials and the needs of a particular patient. Human dosage amounts can initially be determined by extrapolating from the amount of compound used in mice, as a skilled artisan recognizes it is routine in the art to modify the dosage for humans compared to animal models. In certain embodiments it is envisioned that the dosage may vary from between about 1 mg compound/Kg body weight to about 5000 mg compound/Kg body weight; or from about 5 mg/Kg body weight to about 4000 mg/Kg body weight or from about 10 mg/Kg body weight to about 3000 mg/Kg body weight; or from about 50 mg/Kg body weight to about 2000 mg/Kg body weight; or from about 100 mg/Kg body weight to about 1000 mg/Kg body weight; or from about 150 mg/Kg body weight to about 500 mg/Kg body weight. In other embodiments this dose may be about 1, 5, 10, 25, 50, 75, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, 1000, 1050, 1100, 1150, 1200, 1250, 1300, 1350, 1400, 1450, 1500, 1600, 1700, 1800, 1900, 2000, 2500, 3000, 3500, 4000, 4500, 5000 mg/Kg body weight. In other embodiments, it is envisaged that higher does may be used, such doses may be in the range of about 5 mg compound/Kg body to about 20 mg compound/Kg body. In other embodiments the doses may be about 8, 10, 12, 14, 16 or 18 mg/Kg body weight. Of course, this dosage amount may be adjusted upward or downward, as is routinely done in such treatment protocols, depending on the results of the initial clinical trials and the needs of a particular patient. [0090]
  • IV. Kits [0091]
  • Any of the compositions described herein may be comprised in a kit. In a non-limiting example, a nuclear hormone receptor agonist or ligand, and in some embodiments, at least one additional agent, may be comprised in a kit. [0092]
  • The kits may comprise a suitably aliquoted nuclear hormone receptor ligand, and/or additional agent compositions of the present invention, whether labeled or unlabeled, as may be used to prepare a standard curve for treatment of macular degeneration, such as AMD. The components of the kits may be packaged in aqueous media or in lyophilized form. When reagents and/or components are provided as a dry powder, the powder can be reconstituted by the addition of a suitable solvent. It is envisioned that the solvent may also be provided in another container means. [0093]
  • The container means of the kits will generally include at least one vial, test tube, flask, bottle, syringe or other container means, into which a component may be placed, and preferably, suitably aliquoted. Where there are more than one component in the kit, the kit also will generally contain a second, third or other additional container into which the additional components may be separately placed. However, various combinations of components may be comprised in a vial. The kits of the present invention also will typically include a means for containing the nuclear hormone receptor ligand, additional agent, and any other reagent containers in close confinement for commercial sale. Such containers may include injection or blow-molded plastic containers into which the desired vials are retained. [0094]
    • EXAMPLES
  • The following is an illustration of preferred embodiments for practicing the present invention. However, they are not limiting examples. Other examples and methods are possible in practicing the present invention. [0095]
    • Example 1 Materials and Methods
  • Cell Culture and Drug Treatments [0096]
  • Primary cultures of normal human RPE cells from passages 5 to 10 were used for the experiments described. RPE cells were grown to confluence on laminin-coated 6 well Transwell tissue culture plates (Costar) with DMEM-H21 containing 10% fetal bovine serum, 2 mM glutamine, 50 μg/ml gentamicin and 2.5 mg/ml fungizone in the top and bottom chambers. For immunofluorescent staining cells were grown on laminin coated slides in the same medium. Cells were grown for at least 1 week at confluence prior to drug treatment. Cells to be treated with drugs were incubated in serum free DMEM-H21 prior to drug addition. Drug treatments were in serum free DMEM-H21 with or without 10[0097] −7 M thyroid hormone (T3), 2.5×10−6 M 22 (R) hydroxycholesterol, or 10−7 M cis retinoic acid in both chambers for 36 hours.
  • RT-PCR [0098]
  • Confluent cell cultures were harvested and total RNA was purified using RNAzol (Teltest, Inc., Friendswood, Tex.) according to the manufacturer's instructions. Equal amounts of purified RNA were used in each reaction as templates for cDNA synthesis using the 1st Strand Synthesis Kit for RT-PCR (AMV) (Boehringer, Indianapolis, Ind.). RT-PCR was carried out on 1 μg of cDNA with Amplitaq Taq polymerase (Perkin-Elmer, Branchburg, N.J.). In some experiments apo E RT-PCR products were quantified using the QuantumRNA assay kit according to the manufacturer's instructions (Ambion, Austin, Tex.). Briefly, 18S rRNA and apo E cDNAs are simultaneously amplified in each reaction. The RT-PCR products are resolved by electrophoresis on 1.4% agarose gels. The apo E mRNA expression is assessed relative to the internal 18S rRNA expression by densitometric analysis of photographed agarose gels. [0099]
  • RT-PCR primers specific to human apo E, ABCA1, SR-BI, SR-BII, and 1xr a were used. The RT-PCR product of the predicted sizes for the apo E, ABCA1, SR-BI, and SR-BII RT-PCR products were excised form the gel and their identities were confirmed by DNA sequencing (not shown). [0100]
  • Immunofluoresence Microscopy [0101]
  • RPE cells, grown on slides, were σταινεδ with either antisera to ABCA1, or with purified antibodies to SR-BI or SR-BII. Cells were fixed in ice cold 100% MeOH for 20 min. All subsequent steps were performed at room temperature. Cells were washed in phosphate buffered saline (PBS) and incubated for in 5% goat serum in PBS for 30 min. Cells were then washed in buffer A (150 mM NaCl, 10 mM phosphate, pH 7.8) and incubated with the primary antibody in buffer A for 45 min. After washing with buffer A the cells were incubated in Avidin Blocking Reagent (Vector Laboratories, Burlingame, Calif.) for 15 min, washed in buffer A again and incubated in Biotin Blocking Reagent (Vector Laboratories, Burlingame, Calif.) for 15 min. After washing in buffer A, cells were incubated in 10 μg/ml biotinylated goat anti-rabbit IgG (Vector Laboratories, Burlingame, Calif.) in buffer A for 30 min, washed in buffer A and incubated in 20 μg/ml fluorescein conjugated avidin D (Vector Laboratories, Burlingame, Calif.) in buffer B (150 mM NaCl, 100 mM sodium bicarbonate, pH 8.5) for 30 min. The cells were washed in buffer B and a cover slip was added to each slide, over a few drops of Vectashield (Vector Laboratories, Burlingame, Calif.). The slides were stored in the dark until ready for microscopic examination. [0102]
  • Apo E Western Blotting [0103]
  • Cells were treated with Media was concentrated 20-fold by centrifugal ultrafiltration ([0104] VIVA SPIN 20, MCO 5,000, Viva Sciences, Hannover, Germany), dialyzed against 0.15M NaCl, 1 mM sodium EDTA, 0.025% sodium azide (SalEN). Total protein content was determined by a modified Lowry assay (BioRad DC kit, Richmond, Calif.). Concentrated media (50 μg protein) was made to Start Buffer (0.025 M NaCl, 0.010 M tris (pH 8.5), 5 mM MnCl2) and adsorbed onto a 0.1 ml column containing Heparin-Sepharose CL-4B (Pharmacia, Uppsala, Sweden). Following a 2 ml wash in Start Buffer, the apo E containing bound fraction was eluted with 0.5M NaCl in Start buffer. The eluate was concentrated to 20 μl and buffer-exchanged to SalEN by centrifugal ultrafiltration (Biomax, 5k MCO, Millipore, Bedford, Mass.). Apo E was resolved by tris-tricine buffered SDS-PAGE (5-25% linear acrylamide gradient) and proteins electrophoetically transferred (55V, 18 h) to nitrocelluose membrane filters (Schleicher and Shuell, Keen, N H). Membranes were blocked with 10% bovine serum albumin at room temperature and probed with 1% goat anti-human apo E antiserum (18 h, 3° C.) prepared in 0.15% NaCl, 1 mM EDTA (pH 7.4), 0.1% Triton X-100 (SalET). The primary-bound anti-apo E antibodies were detected calorimetrically with horseradish peroxidase conjugated rabbit anti-goat Ig (H+L) and NiCl2-enhanced diaminobenzine staining. Stained bands were compared densitometrically from the digitized scanned image (NIH Image, v.1.62). Anti apo E antibodies were obtained by hyper-immunization of goats with purified apo E or obtained from Assay Designs (A299, Ann Arbor, Mich.)
  • Lipoprotein fractions were prepared from conditioned media that was adjusted with solid KBr to a density of 1.21 g/ml. Samples were ultracentrifuged in a Beckman 42.2 Ti rotor at 40,000 rpm for 18 h at 110° C. The lipoprotein and lipoprotein-free fractions, the top and bottom 50 μl, respectively, were dialysed against SalEN prior to analysis. [0105]
  • [[0106] 14C] Docosohexanoic Acid (DHA) Labeled POS Uptake and Transport
  • Bovine outer photoreceptor outer segments (POS) were labeled by incubating for with Coenzyme A, ATP, Mg[0107] 2+, and [14C]-DHA. Cells grown on laminin coated Transwell plates were incubated with 12 μg/ml labeled POS in the apical chamber for 36 hours in medium containing 10% lipoprotein deficient fetal bovine serum. The basal medium was subjected to scintillation counting to determine the amount of [14C] labeled lipids transported through the RPE cells.
  • Identification of Acceptors for Exported [0108] 14C Lipids
  • Bovine outer photoreceptor outer segments (POS) were labeled by incubating for with Coenzyme A, ATP, Mg[0109] 2+, and [14C]-DHA. Cells grown on laminin coated Transwell plates were incubated with 12 μg/ml labeled POS in the apical chamber for 36 hours in medium containing 10% lipoprotein deficient fetal bovine serum. The basal chambers contained either 1 mg/ml human HDL, 1 mg/ml human LDL or 100% human plasma. The basal medium was collected and lipoproteins were repurified from by potassium bromide density gradient centrifugation at d=1.21 g/ml (Beckman 42.2 Ti rotor, 40,000 rpm, 18 h, 10° C.), dialyzed, and resolved by size in nondenaturing 0-35% PAGE. Gels were stained with coomassie blue R-250. Gel lanes were sectioned into thirty 2 mm slices that were digested (TS-1, Research Products International) and radioactivity quanitfied by liquid scintillation spectrometry.
    • Example 2 Expression of Transporters in RPE Cells
  • One skilled in the art recognizes that certain RCT components in cultured human RPE cells have been demonstrated (Mullins et al., 2000; Anderson et al., 2001). Nuclear hormone receptors known to regulate expression of reverse cholesterol transport proteins are also expressed in cultured human RPE. [0110]
  • A skilled artisan recognizes that there is expression of TRs and RXRs in RPE cells in culture (Duncan et al. 1999). RT-PCR of human RPE cell cDNA revealed that these cells also express mRNAs for apo E, ABCA1, SR-BI, SR-BII and 1xr α. As shown in FIG. 1 [0111] lane 1, FIG. 1 lane 2 and FIG. 1 lane 3, RPE cells express mRNAs for apo E, ABCA1 and 1xr α, respectively.
  • As shown in FIG. 2, [0112] lane 1, and FIG. 2, lane 2, RPE cells express mRNA for SR-BI and SR-BII respectively.
  • Furthermore, in immunofluoresence microscopy experiments, RPE cells stain strongly for SR-BI (FIG. 3A) and SR-BII (FIG. 3B). Control non-specific IgG or antibody vehicle did not stain RPE cells (FIGS. 3C and 3D, respectively). Expression of SR-BI and SR-BII in these cells was confirmed by PCR. [0113]
  • Expression of ABCA1 protein was demonstrated by immunofluorescent staining of RPE cells with an antibody to ABCA1 (FIG. 4). Cell nuclei were stained with DAPI. [0114]
    • Example 3 Regulation of Apo E Secretion in RPE Cells
  • In order to distinguish apical (A) from basally (B) secreted apo E, RPE cells were cultured on laminin-coated Transwell plates. Specifically, human cultured RPE (passage 2-10, 35 y.o. donor) were placed on laminin-coated Transwell plates, wherein the upper and lower wells both had serum-free media. Total protein and apo E-specific protein concentrations were measured from media pooled and concentrated from 3-6 replicate wells. To assess apo E-specific secretion, apo E was purified from conditioned media by heparin-sepharose affinity chromatography and visualized by western blotting. Apo E concentrations were consistently greater in the basolateral media (FIG. 5, [0115] lane 1 vs. lane 2). These data demonstrate that RPE cells display polarized secretion of cellular proteins, including apo E. Thus, this indicated that Apo E is preferentially secreted basally, supporting its role in RCT.
  • Since RPE cells express 1xr α as well as thyroid hormone receptors (TRs) and retinoid-X-receptors (RXRs), the effect of 10[0116] −7 M T3, 2.5×10−6 M 22 (R) hydroxycholesterol (HC) (an 1xr α agonist), or 10−7 M cis retinoic acid (cRA) (an RXR agonist) on apo E secretion from RPE cells was tested. FIG. 6 illustrates the same experimental procedure as described above, but with basal and apical media both containing the following compounds for a 36 hour incubation: T3 (10−7) M (T); 9 cis-RA (10−6) M (RA); and 22 (R) hydroxycholesterol 2.5 (10 −6) M (HC). The basal media was analyzed for Apo E expression with Western blot, and the results showed increased basal expression of Apo E with the compound treatments. Thus, as before, polarized apo E secretion was observed and, in this case, occurred in the presence of T3, HC or cRA, indicating that an increase in levels of basally secreted apo E is the result of administration of these compounds to RPE cells.
    • Example 4 Assay of Efflux from RPE Cells
  • This example characterizes efflux of POS residues from RPE cells, particularly regarding binding to HDL. Giusto et al. (1986) describes a method of [0117] 14C decoshexanoic acid (DHA) labeling of bovine photoreceptor outer segment (POS) lipids. Generally, an approximately 36 hour incubation over human RPE cells wherein the basal medium contains plasma, HDL, or LDL is followed by centrifugation of the basal media to collect lipoprotein fraction, which is then analyzed to determine distribution of radioactivity.
  • Specifically, bovine photoreceptor outer segment (POS) are labeled with [0118] 14C decoshexanoic acid (DHA) and placed in lipoprotein deficient media. Following this, they are placed over cultured human RPE on Transwell plates for 36 hours, and the basal medium contained either 100% plasma, HDL (1 mg/cc) or LDL (1 mg/cc). After 36 hours, basal media was centrifuged to collect lipoprotein fraction (density 1.2). This fraction was then run on a non-denaturing gel and stained with Coomassie blue. FIG. 7 shows LDL and HDL fractions, both separately and together in plasma (PL). The PL fraction contains the same amount of HDL and LDL as each of the separated fractions (HDL, LDL).
  • The PA gel was cut into about 1 mm pieces, and the radioactivity distribution was determined (FIG. 8). With either LDL or HDL alone, counts were observed over respective lipoprotein fractions. When both LDL and HDL in plasma are present, counts localize preferentially over HDL fraction. This indicates that following phagocytosis of POS by RPE, POS residues are effluxed and preferentially bound by HDL. This is a novel demonstration illustrating that RCT to an HDL acceptor occurs in RPE cells. [0119]
  • To characterize the lipids in the lipoprotein fraction, thin layer chromatography was performed. Acid charring was used to identify lipid containing spots. The spots were scraped off of the plate and [0120] 14C was quantified by liquid scintillation counting. Six of 17 14C-containing spots were identified with standards shown (FIG. 9). Eleven 14C-containing spots bound to HDL remain unidentified and could be unique serum marker(s) for patients with early AMD.
  • Thus, in an embodiment of the present invention, a patient sample is obtained, such as by drawing blood, and the HDL is examined for bound POS residues. From this, a determination of their risk of visual loss from AMD is made. In a specific embodiment, the profile of bound POS residues is indicative of identifying an individual afflicted with ocular disease and/or of identifying an individual at risk for developing an ocular disease. [0121]
    • Example 5 Modulation of RCT by Compound Administration
  • This experiment determines whether compound administration can upregulate efflux of labeled POS residues to HDL, particularly by showing regulation of [0122] 14C-DHA labeled POS efflux into basal media. An assay similar to that described in Example 4 is utilized; however, in this Example the cells were treated with T3, 9 cis-retinoic acid, and 22 (R) hydroxycholesterol in the concentrations described above for 36 hours. Total radioactivity (cpm) in the absence of HDL purification was determined by liquid scintillation counting of the basal media. FIG. 10 indicates that compound treatments increase RCT by cultured human RPE cells.
  • Specifically, cells were grown for 1 to 2 weeks at confluence on Transwell plates. [0123] 14C-labeled POS (30 mg/ml) were added to the apical medium. The apical and basal medium comprised either 10−7 M T3, 2.5×10−5 M 22 (R) hydroxycholesterol, or 10−7 M cis retinoic acid. The basal medium contained 1 mg/ml HDL. After 36 hours the basal medium was collected and 14C counts were determined by scintillation counting. As stated, all of the compound treatments increased transport of 14C-labeled POS to the basal medium.
  • The effect of T3 on Apo E mRNA levels was also assessed by RT-PCR. Treatment with [0124] 10 −7 M T3 resulted in a 1.5 to 2-fold increase in apo E mRNA levels, suggesting that T3 is acting, at least in part, to increase apo E levels at the mRNA level. In specific embodiments, administration of 9 cis-retinoic acid and 22 (R) hydroxycholesterol similarly upregulates expression of apo E.
  • Thus, in a specific embodiment, RCT is regulated via nuclear hormone receptor ligands. For example, ABCA1 expression is upregulated by binding of LXR and RXR agonists to their respective nuclear hormone receptors (FIG. 11). Since these receptors form heterodimers bound to the ABCA1 promoter, ligand binding increases expression of ABCA1 and, hence, RCT. [0125]
    • Example 6 Identification of HDL as Lipid Acceptor from RPE Cells
  • In the presence of added purified human LDL and HDL, radiolabeled lipid efflux is enhanced (FIG. 12). As shown graphically, efflux (bottoms in graph) was greatly enhanced by the presence of plasma (PL in graph), HDL or LDL, as compared to no addition to the bottom medium (left side of graph). [0126]
  • As shown in FIG. 8, when whole human EDTA-plasma is employed and lipoproteins are isolated, [[0127] 14C]-labeled lipids are incorporated into LDL and HDL. However, radiolabel preferentially associated with HDL. Furthermore, the radiolabel in HDL was localized to the larger HDL 2 subspecies, which include the HDL particles enriched in apo E. This result suggests that lipid efflux from RPE is enhanced by the apo E-containing HDL.
    • Example 7 Reduction of BM Lipids Via Scavenger Receptors (SRS)
  • Scavenger receptors in macrophages function to phagocytose oxLDL molecules. There are types of SRs previously described in macrophages including SR-A1, SR-A2, SR-B1, SR-B2, CD36, and LOX. SRs are distinct from LDL receptors in that levels of expression for SRs are upregulated by oxLDL. This upregulation by intracellular oxLDL levels is modulated by nuclear hormone receptors, peroxisome proliferator activated receptor (PPAR) and retinoic acid X receptor (RXR), that exert transcriptional control of CD36 expression. Because the earliest lesion of AS, the fatty streak, consists of macrophages engulfed with excessive oxLDL, and because RPE cells similarly become filled with lipid inclusions in AMD, SR expression was studied in RPE cells. Expression of the following SRs in RPE cells was identified: CD36 (confirmation of previous investigators), SR-A1, SR-A2 (both first time demonstrated in RPE), SR-B1, SR-B2 (both first time demonstrated in RPE). [0128]
  • The inventors have also shown that, like macrophages, oxLDL upregulates expression of CD36 in RPE cells (FIG. 13). Additionally, RPE cells express the nuclear hormone receptors, PPAR and RXR, indicating control mechanisms for SR expression are analogous between the cell types. Thus, in specific embodiments the expression of RPE SRs in patients is controlled with PPAR and RXR ligands (e.g. PG-J2, thiazolidinediones, cis-retinoic acid). This controls the rate at which RPE cells phagocytose oxidized photoreceptor outer segments, and hence slows the rate at which abnormal lipid inclusions accumulate in RPE and BM. In other specific embodiments, expression of CD36 is downregulated with a composition such as tamoxifen, TGF-beta or INF-gamma. Similarly, regulating expression of other RPE SRs would control levels of lipids in both RPE and BM. For example, for SR-A regulation IGF-1, TGF-beta, EGF, and/or PDGF is used, and for SR-B regulation cAMP and/or estradiol (for upregulation) or TNF-alpha, LPS, and/or INF-gamma (for downregulation) is used. [0129]
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  • All patents and publications mentioned in the specification are indicative of the level of those skilled in the art to which the invention pertains. All patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference. The references, to the extent that they provide exemplary procedural or other details supplementary to those set forth herein, are specifically incorporated herein by reference. [0130]
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  • Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims. Moreover, the scope of the present application is not intended to be limited to the particular embodiments of the process, machine, manufacture, composition of matter, means, methods and steps described in the specification. As one of ordinary skill in the art will readily appreciate from the disclosure of the present invention, processes, machines, manufacture, compositions of matter, means, methods, or steps, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized according to the present invention. Accordingly, the appended claims are intended to include within their scope such processes, machines, manufacture, compositions of matter, means, methods, or steps. [0175]
  • 1 12 1 1156 DNA Human 1 cgcagcggag gtgaaggacg tccttcccca ggagccgact ggccaatcac aggcaggaag 60 atgaaggttc tgtgggctgc gttgctggtc acattcctgg caggatgcca ggccaaggtg 120 gagcaagcgg tggagacaga gccggagccc gagctgcgcc agcagaccga gtggcagagc 180 ggccagcgct gggaactggc actgggtcgc ttttgggatt acctgcgctg ggtgcagaca 240 ctgtctgagc aggtgcagga ggagctgctc agctcccagg tcacccagga actgagggcg 300 ctgatggacg agaccatgaa ggagttgaag gcctacaaat cggaactgga ggaacaactg 360 accccggtgg cggaggagac gcgggcacgg ctgtccaagg agctgcaggc ggcgcaggcc 420 cggctgggcg cggacatgga ggacgtgtgc ggccgcctgg tgcagtaccg cggcgaggtg 480 caggccatgc tcggccagag caccgaggag ctgcgggtgc gcctcgcctc ccacctgcgc 540 aagctgcgta agcggctcct ccgcgatgcc gatgacctgc agaagcgcct ggcagtgtac 600 caggccgggg cccgcgaggg cgccgagcgc ggcctcagcg ccatccgcga gcgcctgggg 660 cccctggtgg aacagggccg cgtgcgggcc gccactgtgg gctccctggc cggccagccg 720 ctacaggagc gggcccaggc ctggggcgag cggctgcgcg cgcggatgga ggagatgggc 780 agccggaccc gcgaccgcct ggacgaggtg aaggagcagg tggcggaggt gcgcgccaag 840 ctggaggagc aggcccagca gatacgcctg caggccgagg ccttccaggc ccgcctcaag 900 agctggttcg agcccctggt ggaagacatg cagcgccagt gggccgggct ggtggagaag 960 gtgcaggctg ccgtgggcac cagcgccgcc cctgtgccca gcgacaatca ctgaacgccg 1020 aagcctgcag ccatgcgacc ccacgccacc ccgtgcctcc tgcctccgcg cagcctgcag 1080 cgggagaccc tgtccccgcc ccagccgtcc tcctggggtg gaccctagtt taataaagat 1140 tcaccaagtt tcacgc 1156 2 5515 DNA Human 2 ggaacttgat gctcagagag gacaagtcat ttgcccaagg tcacacagct ggcaactggc 60 agacgagatt cacgccctgg caatttgact ccagaatcct aaccttaacc cagaagcacg 120 gcttcaagcc ctggaaacca caatacctgt ggcagccagg gggaggtgct ggaatctcat 180 ttcacatgtg gggagggggc tcctgtgctc aaggtcacaa ccaaagagga agctgtgatt 240 aaaacccagg tcccatttgc aaagcctcga cttttagcag gtgcatcata ctgttcccac 300 ccctcccatc ccacttctgt ccagccgcct agccccactt tctttttttt ctttttttga 360 gacagtctcc ctcttgctga ggctggagtg cagtggcgag atctcggctc actgtaacct 420 ccgcctcccg ggttcaagcg attctcctgc ctcagcctcc caagtagcta ggattacagg 480 cgcccgccac cacgcctggc taacttttgt atttttagta gagatggggt ttcaccatgt 540 tggccaggct ggtctcaaac tcctgacctt aagtgattcg cccactgtgg cctcccaaag 600 tgctgggatt acaggcgtga gctaccgccc ccagcccctc ccatcccact tctgtccagc 660 cccctagccc tactttcttt ctgggatcca ggagtccaga tccccagccc cctctccaga 720 ttacattcat ccaggcacag gaaaggacag ggtcaggaaa ggaggactct gggcggcagc 780 ctccacattc cccttccacg cttggccccc agaatggagg agggtgtctg tattactggg 840 cgaggtgtcc tcccttcctg gggactgtgg ggggtggtca aaagacctct atgccccacc 900 tccttcctcc ctctgccctg ctgtgcctgg ggcaggggga gaacagccca cctcgtgact 960 gggctgccca gcccgcccta tccctggggg agggggcggg acagggggag ccctataatt 1020 ggacaagtct gggatccttg agtcctactc agccccagcg gaggtgaagg acgtccttcc 1080 ccaggagccg gtgagaagcg cagtcggggg cacggggatg agctcagggg cctctagaaa 1140 gagctgggac cctgggaagc cctggcctcc aggtagtctc aggagagcta ctcggggtcg 1200 ggcttgggga gaggaggagc gggggtgagg caagcagcag gggactggac ctgggaaggg 1260 ctgggcagca gagacgaccc gacccgctag aaggtggggt ggggagagca gctggactgg 1320 gatgtaagcc atagcaggac tccacgagtt gtcactatca ttatcgagca cctactgggt 1380 gtccccagtg tcctcagatc tccataactg gggagccagg ggcagcgaca cggtagctag 1440 ccgtcgattg gagaacttta aaatgaggac tgaattagct cataaatgga acacggcgct 1500 taactgtgag gttggagctt agaatgtgaa gggagaatga ggaatgcgag actgggactg 1560 agatggaacc ggcggtgggg agggggtggg gggatggaat ttgaaccccg ggagaggaag 1620 atggaatttt ctatggaggc cgacctgggg atggggagat aagagaagac caggagggag 1680 ttaaataggg aatgggttgg gggcggcttg gtaaatgtgc tgggattagg ctgttgcaga 1740 taatgcaaca aggcttggaa ggctaacctg gggtgaggcc gggttggggg cgctgggggt 1800 gggaggagtc ctcactggcg gttgattgac agtttctcct tccccagact ggccaatcac 1860 aggcaggaag atgaaggttc tgtgggctgc gttgctggtc acattcctgg caggtatggg 1920 ggcggggctt gctcggttcc ccccgctcct ccccctctca tcctcacctc aacctcctgg 1980 ccccattcag acagaccctg ggccccctct tctgaggctt ctgtgctgct tcctggctct 2040 gaacagcgat ttgacgctct ctgggcctcg gtttccccca tccttgagat aggagttaga 2100 agttgttttg ttgttgttgt ttgttgttgt tgttttgttt ttttgagatg aagtctcgct 2160 ctgtcgccca ggctggagtg cagtggcggg atctcggctc actgcaagct ccgcctccca 2220 ggtccacgcc attctcctgc ctcagcctcc caagtagctg ggactacagg cacatgccac 2280 cacacccgac taactttttt gtattttcag tagagacggg gtttcaccat gttggccagg 2340 ctggtctgga actcctgacc tcaggtgatc tgcccgtttc gatctcccaa agtgctggga 2400 ttacaggcgt gagccaccgc acctggctgg gagttagagg tttctaatgc attgcaggca 2460 gatagtgaat accagacacg gggcagctgt gatctttatt ctccatcacc cccacacagc 2520 cctgcctggg gcacacaagg acactcaata catgcttttc cgctgggccg gtggctcacc 2580 cctgtaatcc cagcactttg ggaggccaag gtgggaggat cacttgagcc caggagttca 2640 acaccagcct gggcaacata gtgagaccct gtctctacta aaaatacaaa aattagccag 2700 gcatggtgcc acacacctgt gctctcagct actcaggagg ctgaggcagg aggatcgctt 2760 gagcccagaa ggtcaaggtt gcagtgaacc atgttcaggc cgctgcactc cagcctgggt 2820 gacagagcaa gaccctgttt ataaatacat aatgctttcc aagtgattaa accgactccc 2880 ccctcaccct gcccaccatg gctccaaaga agcatttgtg gagcaccttc tgtgtgcccc 2940 taggtagcta gatgcctgga cggggtcaga aggaccctga cccgaccttg aacttgttcc 3000 acacaggatg ccaggccaag gtggagcaag cggtggagac agagccggag cccgagctgc 3060 gccagcagac cgagtggcag agcggccagc gctgggaact ggcactgggt cgcttttggg 3120 attacctgcg ctgggtgcag acactgtctg agcaggtgca ggaggagctg ctcagctccc 3180 aggtcaccca ggaactgagg tgagtgtccc catcctggcc cttgaccctc ctggtgggcg 3240 gctatacctc cccaggtcca ggtttcattc tgcccctgtc gctaagtctt ggggggcctg 3300 ggtctctgct ggttctagct tcctcttccc atttctgact cctggcttta gctctctgga 3360 attctctctc tcagctttgt ctctctctct tcccttctga ctcagtctct cacactcgtc 3420 ctggctctgt ctctgtcctt ccctagctct tttatataga gacagagaga tggggtctca 3480 ctgtgttgcc caggctggtc ttgaacttct gggctcaagc gatcctcccg cctcggcctc 3540 ccaaagtgct gggattagag gcatgagcac cttgcccggc ctcctagctc cttcttcgtc 3600 tctgcctctg ccctctgcat ctgctctctg catctgtctc tgtctccttc tctcggcctc 3660 tgccccgttc cttctctccc tcttgggtct ctctggctca tccccatctc gcccgcccca 3720 tcccagccct tctcccccgc ctccccactg tgcgacaccc tcccgccctc tcggccgcag 3780 ggcgctgatg gacgagacca tgaaggagtt gaaggcctac aaatcggaac tggaggaaca 3840 actgaccccg gtggcggagg agacgcgggc acggctgtcc aaggagctgc aggcggcgca 3900 ggcccggctg ggcgcggaca tggaggacgt gcgcggccgc ctggtgcagt accgcggcga 3960 ggtgcaggcc atgctcggcc agagcaccga ggagctgcgg gtgcgcctcg cctcccacct 4020 gcgcaagctg cgtaagcggc tcctccgcga tgccgatgac ctgcagaagc gcctggcagt 4080 gtaccaggcc ggggcccgcg agggcgccga gcgcggcctc agcgccatcc gcgagcgcct 4140 ggggcccctg gtggaacagg gccgcgtgcg ggccgccact gtgggctccc tggccggcca 4200 gccgctacag gagcgggccc aggcctgggg cgagcggctg cgcgcgcgga tggaggagat 4260 gggcagccgg acccgcgacc gcctggacga ggtgaaggag caggtggcgg aggtgcgcgc 4320 caagctggag gagcaggccc agcagatacg cctgcaggcc gaggccttcc aggcccgcct 4380 caagagctgg ttcgagcccc tggtggaaga catgcagcgc cagtgggccg ggctggtgga 4440 gaaggtgcag gctgccgtgg gcaccagcgc cgcccctgtg cccagcgaca atcactgaac 4500 gccgaagcct gcagccatgc gaccccacgc caccccgtgc ctcctgcctc cgcgcagcct 4560 gcagcgggag accctgtccc cgccccagcc gtcctcctgg ggtggaccct agtttaataa 4620 agattcacca agtttcacgc atctgctggc ctccccctgt gatttcctct aagccccagc 4680 ctcagtttct ctttctgccc acatactgcc acacaattct cagccccctc ctctccatct 4740 gtgtctgtgt gtatctttct ctctgccctt tttttttttt tagacggagt ctggctctgt 4800 cacccaggct agagtgcagt ggcacgatct tggctcactg caacctctgc ctcttgggtt 4860 caagcgattc tgctgcctca gtagctggga ttacaggctc acaccaccac acccggctaa 4920 tttttgtatt tttagtagag acgagctttc accatgttgg ccaggcaggt ctcaaactcc 4980 tgaccaagtg atccacccgc cggcctccca aagtgctgag attacaggcc tgagccacca 5040 tgcccggcct ctgcccctct ttctttttta gggggcaggg aaaggtctca ccctgtcacc 5100 cgccatcaca gctcactgca gcctccacct cctggactca agtgataagt gatcctcccg 5160 cctcagcctt tccagtagct gagactacag gcgcatacca ctaggattaa tttggggggg 5220 ggtggtgtgt gtggagatgg ggtctggctt tgttggccag gctgatgtgg aattcctggg 5280 ctcaagcgat actcccacct tggcctcctg agtagctgag actactggct agcaccacca 5340 cacccagctt tttattatta tttgtagaga caaggtctca atatgttgcc caggctagtc 5400 tcaaacccct ggctcaagag atcctccgcc atcggcctcc caaagtgctg ggattccagg 5460 catgggctcc gagcggcctg cccaacttaa taatattgtt cctagagttg cactc 5515 3 1157 DNA Human 3 ccccagcgga ggtgaaggac gtccttcccc aggagccgac tggccaatca caggcaggaa 60 gatgaaggtt ctgtgggctg cgttgctggt cacattcctg gcaggatgcc aggccaaggt 120 ggagcaagcg gtggagacag agccggagcc cgagctgcgc cagcagaccg agtggcagag 180 cggccagcgc tgggaactgg cactgggtcg cttttgggat tacctgcgct gggtgcagac 240 actgtctgag caggtgcagg aggagctgct cagctcccaa gtcacccaag aactgagggc 300 gctgatggac gagaccatga aggagttgaa ggcctacaaa tcggaactgg aggaacaact 360 gaccccggta gcggaggaga cgcgggcacg gctgtccaag gagctgcaga cggcgcaggc 420 ccggctgggc gcggacatgg aggacgtgtg cggccgcctg gtgcagtacc gcggcgaggt 480 gcaggccatg ctcggccaga gcaccgagga gctgcgggtg cgcctcgcct cccacctgcg 540 caagctgcgt aagcggctcc tccgcgatcc cgatgacctg cagaagcgcc tggcagtgta 600 ccaggccggg gcccgcgagg gcgccgagcg cggcctcagc gccatccgcg agcgcctggg 660 gcccctggtg gaacagggcc gcgtgcgggc cgccactgtg ggctccctgg ccggccagcc 720 gctacaggag cgggcccagg cctggggcga gcggctgcgc gcgcggatgg aggagatggg 780 cagtcggacc cgcgaccgcc tggacgaggt gaaggagcag gtggcggagg tgcgcgccaa 840 gctggaggag caggcccagc agatacgcct gcaggccgag gccttccagg cccgcctcaa 900 gagctggttc gagcccctgg tggaagacat gcagcgccag tgggccgggc tggtggagaa 960 ggtgcaggct gccgtgggca ccagcgccgc ccctgtgccc agcgacaatc actgaacgcc 1020 gaagcctgca gccatgcgac cccacgccac cccgtgcctc ctgcctccgc gcagcctgca 1080 gcgggagacc ctgtccccgc cccagccgtc ctcctggggt ggaccctagt ttaataaaga 1140 ttcaccaagt ttcacgc 1157 4 317 PRT Human 4 Met Lys Val Leu Trp Ala Ala Leu Leu Val Thr Phe Leu Ala Gly Cys 1 5 10 15 Gln Ala Lys Val Glu Gln Ala Val Glu Thr Glu Pro Glu Pro Glu Leu 20 25 30 Arg Gln Gln Thr Glu Trp Gln Ser Gly Gln Arg Trp Glu Leu Ala Leu 35 40 45 Gly Arg Phe Trp Asp Tyr Leu Arg Trp Val Gln Thr Leu Ser Glu Gln 50 55 60 Val Gln Glu Glu Leu Leu Ser Ser Gln Val Thr Gln Glu Leu Arg Ala 65 70 75 80 Leu Met Asp Glu Thr Met Lys Glu Leu Lys Ala Tyr Lys Ser Glu Leu 85 90 95 Glu Glu Gln Leu Thr Pro Val Ala Glu Glu Thr Arg Ala Arg Leu Ser 100 105 110 Lys Glu Leu Gln Ala Ala Gln Ala Arg Leu Gly Ala Asp Met Glu Asp 115 120 125 Val Cys Gly Arg Leu Val Gln Tyr Arg Gly Glu Val Gln Ala Met Leu 130 135 140 Gly Gln Ser Thr Glu Glu Leu Arg Val Arg Leu Ala Ser His Leu Arg 145 150 155 160 Lys Leu Arg Lys Arg Leu Leu Arg Asp Ala Asp Asp Leu Gln Lys Arg 165 170 175 Leu Ala Val Tyr Gln Ala Gly Ala Arg Glu Gly Ala Glu Arg Gly Leu 180 185 190 Ser Ala Ile Arg Glu Arg Leu Gly Pro Leu Val Glu Gln Gly Arg Val 195 200 205 Arg Ala Ala Thr Val Gly Ser Leu Ala Gly Gln Pro Leu Gln Glu Arg 210 215 220 Ala Gln Ala Trp Gly Glu Arg Leu Arg Ala Arg Met Glu Glu Met Gly 225 230 235 240 Ser Arg Thr Arg Asp Arg Leu Asp Glu Val Lys Glu Gln Val Ala Glu 245 250 255 Val Arg Ala Lys Leu Glu Glu Gln Ala Gln Gln Ile Arg Leu Gln Ala 260 265 270 Glu Ala Phe Gln Ala Arg Leu Lys Ser Trp Phe Glu Pro Leu Val Glu 275 280 285 Asp Met Gln Arg Gln Trp Ala Gly Leu Val Glu Lys Val Gln Ala Ala 290 295 300 Val Gly Thr Ser Ala Ala Pro Val Pro Ser Asp Asn His 305 310 315 5 317 PRT Human 5 Met Lys Val Leu Trp Ala Ala Leu Leu Val Thr Phe Leu Ala Gly Cys 1 5 10 15 Gln Ala Lys Val Glu Gln Ala Val Glu Thr Glu Pro Glu Pro Glu Leu 20 25 30 Arg Gln Gln Thr Glu Trp Gln Ser Gly Gln Arg Trp Glu Leu Ala Leu 35 40 45 Gly Arg Phe Trp Asp Tyr Leu Arg Trp Val Gln Thr Leu Ser Glu Gln 50 55 60 Val Gln Glu Glu Leu Leu Ser Ser Gln Val Thr Gln Glu Leu Arg Ala 65 70 75 80 Leu Met Asp Glu Thr Met Lys Glu Leu Lys Ala Tyr Lys Ser Glu Leu 85 90 95 Glu Glu Gln Leu Thr Pro Val Ala Glu Glu Thr Arg Ala Arg Leu Ser 100 105 110 Lys Glu Leu Gln Ala Ala Gln Ala Arg Leu Gly Ala Asp Met Glu Asp 115 120 125 Val Arg Gly Arg Leu Val Gln Tyr Arg Gly Glu Val Gln Ala Met Leu 130 135 140 Gly Gln Ser Thr Glu Glu Leu Arg Val Arg Leu Ala Ser His Leu Arg 145 150 155 160 Lys Leu Arg Lys Arg Leu Leu Arg Asp Ala Asp Asp Leu Gln Lys Arg 165 170 175 Leu Ala Val Tyr Gln Ala Gly Ala Arg Glu Gly Ala Glu Arg Gly Leu 180 185 190 Ser Ala Ile Arg Glu Arg Leu Gly Pro Leu Val Glu Gln Gly Arg Val 195 200 205 Arg Ala Ala Thr Val Gly Ser Leu Ala Gly Gln Pro Leu Gln Glu Arg 210 215 220 Ala Gln Ala Trp Gly Glu Arg Leu Arg Ala Arg Met Glu Glu Met Gly 225 230 235 240 Ser Arg Thr Arg Asp Arg Leu Asp Glu Val Lys Glu Gln Val Ala Glu 245 250 255 Val Arg Ala Lys Leu Glu Glu Gln Ala Gln Gln Ile Arg Leu Gln Ala 260 265 270 Glu Ala Phe Gln Ala Arg Leu Lys Ser Trp Phe Glu Pro Leu Val Glu 275 280 285 Asp Met Gln Arg Gln Trp Ala Gly Leu Val Glu Lys Val Gln Ala Ala 290 295 300 Val Gly Thr Ser Ala Ala Pro Val Pro Ser Asp Asn His 305 310 315 6 317 PRT Human 6 Met Lys Val Leu Trp Ala Ala Leu Leu Val Thr Phe Leu Ala Gly Cys 1 5 10 15 Gln Ala Lys Val Glu Gln Ala Val Glu Thr Glu Pro Glu Pro Glu Leu 20 25 30 Arg Gln Gln Thr Glu Trp Gln Ser Gly Gln Arg Trp Glu Leu Ala Leu 35 40 45 Gly Arg Phe Trp Asp Tyr Leu Arg Trp Val Gln Thr Leu Ser Glu Gln 50 55 60 Val Gln Glu Glu Leu Leu Ser Ser Gln Val Thr Gln Glu Leu Arg Ala 65 70 75 80 Leu Met Asp Glu Thr Met Lys Glu Leu Lys Ala Tyr Lys Ser Glu Leu 85 90 95 Glu Glu Gln Leu Thr Pro Val Ala Glu Glu Thr Arg Ala Arg Leu Ser 100 105 110 Lys Glu Leu Gln Thr Ala Gln Ala Arg Leu Gly Ala Asp Met Glu Asp 115 120 125 Val Cys Gly Arg Leu Val Gln Tyr Arg Gly Glu Val Gln Ala Met Leu 130 135 140 Gly Gln Ser Thr Glu Glu Leu Arg Val Arg Leu Ala Ser His Leu Arg 145 150 155 160 Lys Leu Arg Lys Arg Leu Leu Arg Asp Pro Asp Asp Leu Gln Lys Arg 165 170 175 Leu Ala Val Tyr Gln Ala Gly Ala Arg Glu Gly Ala Glu Arg Gly Leu 180 185 190 Ser Ala Ile Arg Glu Arg Leu Gly Pro Leu Val Glu Gln Gly Arg Val 195 200 205 Arg Ala Ala Thr Val Gly Ser Leu Ala Gly Gln Pro Leu Gln Glu Arg 210 215 220 Ala Gln Ala Trp Gly Glu Arg Leu Arg Ala Arg Met Glu Glu Met Gly 225 230 235 240 Ser Arg Thr Arg Asp Arg Leu Asp Glu Val Lys Glu Gln Val Ala Glu 245 250 255 Val Arg Ala Lys Leu Glu Glu Gln Ala Gln Gln Ile Arg Leu Gln Ala 260 265 270 Glu Ala Phe Gln Ala Arg Leu Lys Ser Trp Phe Glu Pro Leu Val Glu 275 280 285 Asp Met Gln Arg Gln Trp Ala Gly Leu Val Glu Lys Val Gln Ala Ala 290 295 300 Val Gly Thr Ser Ala Ala Pro Val Pro Ser Asp Asn His 305 310 315 7 10412 DNA Human 7 gtaattgcga gcgagagtga gtggggccgg gacccgcaga gccgagccga cccttctctc 60 ccgggctgcg gcagggcagg gcggggagct ccgcgcacca acagagccgg ttctcagggc 120 gctttgctcc ttgttttttc cccggttctg ttttctcccc ttctccggaa ggcttgtcaa 180 ggggtaggag aaagagacgc aaacacaaaa gtggaaaaca gttaatgacc agccacggcg 240 tccctgctgt gagctctggc cgctgccttc cagggctccc gagccacacg ctgggggtgc 300 tggctgaggg aacatggctt gttggcctca gctgaggttg ctgctgtgga agaacctcac 360 tttcagaaga agacaaacat gtcagctgct gctggaagtg gcctggcctc tatttatctt 420 cctgatcctg atctctgttc ggctgagcta cccaccctat gaacaacatg aatgccattt 480 tccaaataaa gccatgccct ctgcaggaac acttccttgg gttcagggga ttatctgtaa 540 tgccaacaac ccctgtttcc gttacccgac tcctggggag gctcccggag ttgttggaaa 600 ctttaacaaa tccattgtgg ctcgcctgtt ctcagatgct cggaggcttc ttttatacag 660 ccagaaagac accagcatga aggacatgcg caaagttctg agaacattac agcagatcaa 720 gaaatccagc tcaaacttga agcttcaaga tttcctggtg gacaatgaaa ccttctctgg 780 gttcctgtat cacaacctct ctctcccaaa gtctactgtg gacaagatgc tgagggctga 840 tgtcattctc cacaaggtat ttttgcaagg ctaccagtta catttgacaa gtctgtgcaa 900 tggatcaaaa tcagaagaga tgattcaact tggtgaccaa gaagtttctg agctttgtgg 960 cctaccaagg gagaaactgg ctgcagcaga gcgagtactt cgttccaaca tggacatcct 1020 gaagccaatc ctgagaacac taaactctac atctcccttc ccgagcaagg agctggctga 1080 agccacaaaa acattgctgc atagtcttgg gactctggcc caggagctgt tcagcatgag 1140 aagctggagt gacatgcgac aggaggtgat gtttctgacc aatgtgaaca gctccagctc 1200 ctccacccaa atctaccagg ctgtgtctcg tattgtctgc gggcatcccg agggaggggg 1260 gctgaagatc aagtctctca actggtatga ggacaacaac tacaaagccc tctttggagg 1320 caatggcact gaggaagatg ctgaaacctt ctatgacaac tctacaactc cttactgcaa 1380 tgatttgatg aagaatttgg agtctagtcc tctttcccgc attatctgga aagctctgaa 1440 gccgctgctc gttgggaaga tcctgtatac acctgacact ccagccacaa ggcaggtcat 1500 ggctgaggtg aacaagacct tccaggaact ggctgtgttc catgatctgg aaggcatgtg 1560 ggaggaactc agccccaaga tctggacctt catggagaac agccaagaaa tggaccttgt 1620 ccggatgctg ttggacagca gggacaatga ccacttttgg gaacagcagt tggatggctt 1680 agattggaca gcccaagaca tcgtggcgtt tttggccaag cacccagagg atgtccagtc 1740 cagtaatggt tctgtgtaca cctggagaga agctttcaac gagactaacc aggcaatccg 1800 gaccatatct cgcttcatgg agtgtgtcaa cctgaacaag ctagaaccca tagcaacaga 1860 agtctggctc atcaacaagt ccatggagct gctggatgag aggaagttct gggctggtat 1920 tgtgttcact ggaattactc caggcagcat tgagctgccc catcatgtca agtacaagat 1980 ccgaatggac attgacaatg tggagaggac aaataaaatc aaggatgggt actgggaccc 2040 tggtcctcga gctgacccct ttgaggacat gcggtacgtc tgggggggct tcgcctactt 2100 gcaggatgtg gtggagcagg caatcatcag ggtgctgacg ggcaccgaga agaaaactgg 2160 tgtctatatg caacagatgc cctatccctg ttacgttgat gacatctttc tgcgggtgat 2220 gagccggtca atgcccctct tcatgacgct ggcctggatt tactcagtgg ctgtgatcat 2280 caagggcatc gtgtatgaga aggaggcacg gctgaaagag accatgcgga tcatgggcct 2340 ggacaacagc atcctctggt ttagctggtt cattagtagc ctcattcctc ttcttgtgag 2400 cgctggcctg ctagtggtca tcctgaagtt aggaaacctg ctgccctaca gtgatcccag 2460 cgtggtgttt gtcttcctgt ccgtgtttgc tgtggtgaca atcctgcagt gcttcctgat 2520 tagcacactc ttctccagag ccaacctggc agcagcctgt gggggcatca tctacttcac 2580 gctgtacctg ccctacgtcc tgtgtgtggc atggcaggac tacgtgggct tcacactcaa 2640 gatcttcgct agcctgctgt ctcctgtggc ttttgggttt ggctgtgagt actttgccct 2700 ttttgaggag cagggcattg gagtgcagtg ggacaacctg tttgagagtc ctgtggagga 2760 agatggcttc aatctcacca cttcggtctc catgatgctg tttgacacct tcctctatgg 2820 ggtgatgacc tggtacattg aggctgtctt tccaggccag tacggaattc ccaggccctg 2880 gtattttcct tgcaccaagt cctactggtt tggcgaggaa agtgatgaga agagccaccc 2940 tggttccaac cagaagagaa tatcagaaat ctgcatggag gaggaaccca cccacttgaa 3000 gctgggcgtg tccattcaga acctggtaaa agtctaccga gatgggatga aggtggctgt 3060 cgatggcctg gcactgaatt tttatgaggg ccagatcacc tccttcctgg gccacaatgg 3120 agcggggaag acgaccacca tgtcaatcct gaccgggttg ttccccccga cctcgggcac 3180 cgcctacatc ctgggaaaag acattcgctc tgagatgagc accatccggc agaacctggg 3240 ggtctgtccc cagcataacg tgctgtttga catgctgact gtcgaagaac acatctggtt 3300 ctatgcccgc ttgaaagggc tctctgagaa gcacgtgaag gcggagatgg agcagatggc 3360 cctggatgtt ggtttgccat caagcaagct gaaaagcaaa acaagccagc tgtcaggtgg 3420 aatgcagaga aagctatctg tggccttggc ctttgtcggg ggatctaagg ttgtcattct 3480 ggatgaaccc acagctggtg tggaccctta ctcccgcagg ggaatatggg agctgctgct 3540 gaaataccga caaggccgca ccattattct ctctacacac cacatggatg aagcggacgt 3600 cctgggggac aggattgcca tcatctccca tgggaagctg tgctgtgtgg gctcctccct 3660 gtttctgaag aaccagctgg gaacaggcta ctacctgacc ttggtcaaga aagatgtgga 3720 atcctccctc agttcctgca gaaacagtag tagcactgtg tcatacctga aaaaggagga 3780 cagtgtttct cagagcagtt ctgatgctgg cctgggcagc gaccatgaga gtgacacgct 3840 gaccatcgat gtctctgcta tctccaacct catcaggaag catgtgtctg aagcccggct 3900 ggtggaagac atagggcatg agctgaccta tgtgctgcca tatgaagctg ctaaggaggg 3960 agcctttgtg gaactctttc atgagattga tgaccggctc tcagacctgg gcatttctag 4020 ttatggcatc tcagagacga ccctggaaga aatattcctc aaggtggccg aagagagtgg 4080 ggtggatgct gagacctcag atggtacctt gccagcaaga cgaaacaggc gggccttcgg 4140 ggacaagcag agctgtcttc gcccgttcac tgaagatgat gctgctgatc caaatgattc 4200 tgacatagac ccagaatcca gagagacaga cttgctcagt gggatggatg gcaaagggtc 4260 ctaccaggtg aaaggctgga aacttacaca gcaacagttt gtggcccttt tgtggaagag 4320 actgctaatt gccagacgga gtcggaaagg attttttgct cagattgtct tgccagctgt 4380 gtttgtctgc attgcccttg tgttcagcct gatcgtgcca ccctttggca agtaccccag 4440 cctggaactt cagccctgga tgtacaacga acagtacaca tttgtcagca atgatgctcc 4500 tgaggacacg ggaaccctgg aactcttaaa cgccctcacc aaagaccctg gcttcgggac 4560 ccgctgtatg gaaggaaacc caatcccaga cacgccctgc caggcagggg aggaagagtg 4620 gaccactgcc ccagttcccc agaccatcat ggacctcttc cagaatggga actggacaat 4680 gcagaaccct tcacctgcat gccagtgtag cagcgacaaa atcaagaaga tgctgcctgt 4740 gtgtccccca ggggcagggg ggctgcctcc tccacaaaga aaacaaaaca ctgcagatat 4800 ccttcaggac ctgacaggaa gaaacatttc ggattatctg gtgaagacgt atgtgcagat 4860 catagccaaa agcttaaaga acaagatctg ggtgaatgag tttaggtatg gcggcttttc 4920 cctgggtgtc agtaatactc aagcacttcc tccgagtcaa gaagttaatg atgccatcaa 4980 acaaatgaag aaacacctaa agctggccaa ggacagttct gcagatcgat ttctcaacag 5040 cttgggaaga tttatgacag gactggacac caaaaataat gtcaaggtgt ggttcaataa 5100 caagggctgg catgcaatca gctctttcct gaatgtcatc aacaatgcca ttctccgggc 5160 caacctgcaa aagggagaga accctagcca ttatggaatt actgctttca atcatcccct 5220 gaatctcacc aagcagcagc tctcagaggt ggctctgatg accacatcag tggatgtcct 5280 tgtgtccatc tgtgtcatct ttgcaatgtc cttcgtccca gccagctttg tcgtattcct 5340 gatccaggag cgggtcagca aagcaaaaca cctgcagttc atcagtggag tgaagcctgt 5400 catctactgg ctctctaatt ttgtctggga tatgtgcaat tacgttgtcc ctgccacact 5460 ggtcattatc atcttcatct gcttccagca gaagtcctat gtgtcctcca ccaatctgcc 5520 tgtgctagcc cttctacttt tgctgtatgg gtggtcaatc acacctctca tgtacccagc 5580 ctcctttgtg ttcaagatcc ccagcacagc ctatgtggtg ctcaccagcg tgaacctctt 5640 cattggcatt aatggcagcg tggccacctt tgtgctggag ctgttcaccg acaataagct 5700 gaataatatc aatgatatcc tgaagtccgt gttcttgatc ttcccacatt tttgcctggg 5760 acgagggctc atcgacatgg tgaaaaacca ggcaatggct gatgccctgg aaaggtttgg 5820 ggagaatcgc tttgtgtcac cattatcttg ggacttggtg ggacgaaacc tcttcgccat 5880 ggccgtggaa ggggtggtgt tcttcctcat tactgttctg atccagtaca gattcttcat 5940 caggcccaga cctgtaaatg caaagctatc tcctctgaat gatgaagatg aagatgtgag 6000 gcgggaaaga cagagaattc ttgatggtgg aggccagaat gacatcttag aaatcaagga 6060 gttgacgaag atatatagaa ggaagcggaa gcctgctgtt gacaggattt gcgtgggcat 6120 tcctcctggt gagtgctttg ggctcctggg agttaatggg gctggaaaat catcaacttt 6180 caagatgtta acaggagata ccactgttac cagaggagat gctttcctta acaaaaatag 6240 tatcttatca aacatccatg aagtacatca gaacatgggc tactgccctc agtttgatgc 6300 catcacagag ctgttgactg ggagagaaca cgtggagttc tttgcccttt tgagaggagt 6360 cccagagaaa gaagttggca aggttggtga gtgggcgatt cggaaactgg gcctcgtgaa 6420 gtatggagaa aaatatgctg gtaactatag tggaggcaac aaacgcaagc tctctacagc 6480 catggctttg atcggcgggc ctcctgtggt gtttctggat gaacccacca caggcatgga 6540 tcccaaagcc cggcggttct tgtggaattg tgccctaagt gttgtcaagg aggggagatc 6600 agtagtgctt acatctcata gtatggaaga atgtgaagct ctttgcacta ggatggcaat 6660 catggtcaat ggaaggttca ggtgccttgg cagtgtccag catctaaaaa ataggtttgg 6720 agatggttat acaatagttg tacgaatagc agggtccaac ccggacctga agcctgtcca 6780 ggatttcttt ggacttgcat ttcctggaag tgttctaaaa gagaaacacc ggaacatgct 6840 acaataccag cttccatctt cattatcttc tctggccagg atattcagca tcctctccca 6900 gagcaaaaag cgactccaca tagaagacta ctctgtttct cagacaacac ttgaccaagt 6960 atttgtgaac tttgccaagg accaaagtga tgatgaccac ttaaaagacc tctcattaca 7020 caaaaaccag acagtagtgg acgttgcagt tctcacatct tttctacagg atgagaaagt 7080 gaaagaaagc tatgtatgaa gaatcctgtt catacggggt ggctgaaagt aaagaggaac 7140 tagactttcc tttgcaccat gtgaagtgtt gtggagaaaa gagccagaag ttgatgtggg 7200 aagaagtaaa ctggatactg tactgatact attcaatgca atgcaattca atgcaatgaa 7260 aacaaaattc cattacaggg gcagtgcctt tgtagcctat gtcttgtatg gctctcaagt 7320 gaaagacttg aatttagttt tttacctata cctatgtgaa actctattat ggaacccaat 7380 ggacatatgg gtttgaactc acactttttt tttttttttt gttcctgtgt attctcattg 7440 gggttgcaac aataattcat caagtaatca tggccagcga ttattgatca aaatcaaaag 7500 gtaatgcaca tcctcattca ctaagccatg ccatgcccag gagactggtt tcccggtgac 7560 acatccattg ctggcaatga gtgtgccaga gttattagtg ccaagttttt cagaaagttt 7620 gaagcaccat ggtgtgtcat gctcactttt gtgaaagctg ctctgctcag agtctatcaa 7680 cattgaatat cagttgacag aatggtgcca tgcgtggcta acatcctgct ttgattccct 7740 ctgataagct gttctggtgg cagtaacatg caacaaaaat gtgggtgtct ccaggcacgg 7800 gaaacttggt tccattgtta tattgtccta tgcttcgagc catgggtcta cagggtcatc 7860 cttatgagac tcttaaatat acttagatcc tggtaagagg caaagaatca acagccaaac 7920 tgctggggct gcaagctgct gaagccaggg catgggatta aagagattgt gcgttcaaac 7980 ctagggaagc ctgtgcccat ttgtcctgac tgtctgctaa catggtacac tgcatctcaa 8040 gatgtttatc tgacacaagt gtattatttc tggctttttg aattaatcta gaaaatgaaa 8100 agatggagtt gtattttgac aaaaatgttt gtacttttta atgttatttg gaattttaag 8160 ttctatcagt gacttctgaa tccttagaat ggcctctttg tagaaccctg tggtatagag 8220 gagtatggcc actgccccac tatttttatt ttcttatgta agtttgcata tcagtcatga 8280 ctagtgccta gaaagcaatg tgatggtcag gatctcatga cattatattt gagtttcttt 8340 cagatcattt aggatactct taatctcact tcatcaatca aatatttttt gagtgtatgc 8400 tgtagctgaa agagtatgta cgtacgtata agactagaga gatattaagt ctcagtacac 8460 ttcctgtgcc atgttattca gctcactggt ttacaaatat aggttgtctt gtggttgtag 8520 gagcccactg taacaatact gggcagcctt tttttttttt tttttaattg caacaatgca 8580 aaagccaaga aagtataagg gtcacaagtc taaacaatga attcttcaac agggaaaaca 8640 gctagcttga aaacttgctg aaaaacacaa cttgtgttta tggcatttag taccttcaaa 8700 taattggctt tgcagatatt ggatacccca ttaaatctga cagtctcaaa tttttcatct 8760 cttcaatcac tagtcaagaa aaatataaaa acaacaaata cttccatatg gagcattttt 8820 cagagttttc taacccagtc ttatttttct agtcagtaaa catttgtaaa aatactgttt 8880 cactaatact tactgttaac tgtcttgaga gaaaagaaaa atatgagaga actattgttt 8940 ggggaagttc aagtgatctt tcaatatcat tactaacttc ttccactttt tccagaattt 9000 gaatattaac gctaaaggtg taagacttca gatttcaaat taatctttct atatttttta 9060 aatttacaga atattatata acccactgct gaaaaagaaa aaaatgattg ttttagaagt 9120 taaagtcaat attgatttta aatataagta atgaaggcat atttccaata actagtgata 9180 tggcatcgtt gcattttaca gtatcttcaa aaatacagaa tttatagaat aatttctcct 9240 catttaatat ttttcaaaat caaagttatg gtttcctcat tttactaaaa tcgtattcta 9300 attcttcatt atagtaaatc tatgagcaac tccttacttc ggttcctctg atttcaaggc 9360 catattttaa aaaatcaaaa ggcactgtga actattttga agaaaacaca acattttaat 9420 acagattgaa aggacctctt ctgaagctag aaacaatcta tagttataca tcttcattaa 9480 tactgtgtta ccttttaaaa tagtaatttt ttacattttc ctgtgtaaac ctaattgtgg 9540 tagaaatttt taccaactct atactcaatc aagcaaaatt tctgtatatt ccctgtggaa 9600 tgtacctatg tgagtttcag aaattctcaa aatacgtgtt caaaaatttc tgcttttgca 9660 tctttgggac acctcagaaa acttattaac aactgtgaat atgagaaata cagaagaaaa 9720 taataagccc tctatacata aatgcccagc acaattcatt gttaaaaaac aaccaaacct 9780 cacactactg tatttcatta tctgtactga aagcaaatgc tttgtgacta ttaaatgttg 9840 cacatcattc attcactgta tagtaatcat tgactaaagc catttgtctg tgttttcttc 9900 ttgtggttgt atatatcagg taaaatattt tccaaagagc catgtgtcat gtaatactga 9960 accactttga tattgagaca ttaatttgta cccttgttat tatctactag taataatgta 10020 atactgtaga aatattgctc taattctttt caaaattgtt gcatccccct tagaatgttt 10080 ctatttccat aaggatttag gtatgctatt atcccttctt ataccctaag atgaagctgt 10140 ttttgtgctc tttgttcatc attggccctc attccaagca ctttacgctg tctgtaatgg 10200 gatctatttt tgcactggaa tatctgagaa ttgcaaaact agacaaaagt ttcacaacag 10260 atttctaagt taaatcattt tcattaaaag gaaaaaagaa aaaaaatttt gtatgtcaat 10320 aactttatat gaagtattaa aatgcatatt tctatgttgt aatataatga gtcacaaaat 10380 aaagctgtga cagttctgtt ggtctacaga aa 10412 8 6786 DNA Human 8 atggcttgtt ggcctcagct gaggttgctg ctgtggaaga acctcacttt cagaagaaga 60 caaacatgtc agctgctgct ggaagtggcc tggcctctat ttatcttcct gatcctgatc 120 tctgttcggc tgagctaccc accctatgaa caacatgaat gccattttcc aaataaagcc 180 atgccctctg caggaacact tccttgggtt caggggatta tctgtaatgc caacaacccc 240 tgtttccgtt acccgactcc tggggaggct cccggagttg ttggaaactt taacaaatcc 300 attgtggctc gcctgttctc agatgctcgg aggcttcttt tatacagcca gaaagacacc 360 agcatgaagg acatgcgcaa agttctgaga acattacagc agatcaagaa atccagctca 420 aacttgaagc ttcaagattt cctggtggac aatgaaacct tctctgggtt cctgtatcac 480 aacctctctc tcccaaagtc tactgtggac aagatgctga gggctgatgt cattctccac 540 aaggtatttt tgcaaggcta ccagttacat ttgacaagtc tgtgcaatgg atcaaaatca 600 gaagagatga ttcaacttgg tgaccaagaa gtttctgagc tttgtggcct accaagggag 660 aaactggctg cagcagagcg agtacttcgt tccaacatgg acatcctgaa gccaatcctg 720 agaacactaa actctacatc tcccttcccg agcaaggagc tggctgaagc cacaaaaaca 780 ttgctgcata gtcttgggac tctggcccag gagctgttca gcatgagaag ctggagtgac 840 atgcgacagg aggtgatgtt tctgaccaat gtgaacagct ccagctcctc cacccaaatc 900 taccaggctg tgtctcgtat tgtctgcggg catcccgagg gaggggggct gaagatcaag 960 tctctcaact ggtatgagga caacaactac aaagccctct ttggaggcaa tggcactgag 1020 gaagatgctg aaaccttcta tgacaactct acaactcctt actgcaatga tttgatgaag 1080 aatttggagt ctagtcctct ttcccgcatt atctggaaag ctctgaagcc gctgctcgtt 1140 gggaagatcc tgtatacacc tgacactcca gccacaaggc aggtcatggc tgaggtgaac 1200 aagaccttcc aggaactggc tgtgttccat gatctggaag gcatgtggga ggaactcagc 1260 cccaagatct ggaccttcat ggagaacagc caagaaatgg accttgtccg gatgctgttg 1320 gacagcaggg acaatgacca cttttgggaa cagcagttgg atggcttaga ttggacagcc 1380 caagacatcg tggcgttttt ggccaagcac ccagaggatg tccagtccag taatggttct 1440 gtgtacacct ggagagaagc tttcaacgag actaaccagg caatccggac catatctcgc 1500 ttcatggagt gtgtcaacct gaacaagcta gaacccatag caacagaagt ctggctcatc 1560 aacaagtcca tggagctgct ggatgagagg aagttctggg ctggtattgt gttcactgga 1620 attactccag gcagcattga gctgccccat catgtcaagt acaagatccg aatggacatt 1680 gacaatgtgg agaggacaaa taaaatcaag gatgggtact gggaccctgg tcctcgagct 1740 gacccctttg aggacatgcg gtacgtctgg gggggcttcg cctacttgca ggatgtggtg 1800 gagcaggcaa tcatcagggt gctgacgggc accgagaaga aaactggtgt ctatatgcaa 1860 cagatgccct atccctgtta cgttgatgac atctttctgc gggtgatgag ccggtcaatg 1920 cccctcttca tgacgctggc ctggatttac tcagtggctg tgatcatcaa gggcatcgtg 1980 tatgagaagg aggcacggct gaaagagacc atgcggatca tgggcctgga caacagcatc 2040 ctctggttta gctggttcat tagtagcctc attcctcttc ttgtgagcgc tggcctgcta 2100 gtggtcatcc tgaagttagg aaacctgctg ccctacagtg atcccagcgt ggtgtttgtc 2160 ttcctgtccg tgtttgctgt ggtgacaatc ctgcagtgct tcctgattag cacactcttc 2220 tccagagcca acctggcagc agcctgtggg ggcatcatct acttcacgct gtacctgccc 2280 tacgtcctgt gtgtggcatg gcaggactac gtgggcttca cactcaagat cttcgctagc 2340 ctgctgtctc ctgtggcttt tgggtttggc tgtgagtact ttgccctttt tgaggagcag 2400 ggcattggag tgcagtggga caacctgttt gagagtcctg tggaggaaga tggcttcaat 2460 ctcaccactt cggtctccat gatgctgttt gacaccttcc tctatggggt gatgacctgg 2520 tacattgagg ctgtctttcc aggccagtac ggaattccca ggccctggta ttttccttgc 2580 accaagtcct actggtttgg cgaggaaagt gatgagaaga gccaccctgg ttccaaccag 2640 aagagaatat cagaaatctg catggaggag gaacccaccc acttgaagct gggcgtgtcc 2700 attcagaacc tggtaaaagt ctaccgagat gggatgaagg tggctgtcga tggcctggca 2760 ctgaattttt atgagggcca gatcacctcc ttcctgggcc acaatggagc ggggaagacg 2820 accaccatgt caatcctgac cgggttgttc cccccgacct cgggcaccgc ctacatcctg 2880 ggaaaagaca ttcgctctga gatgagcacc atccggcaga acctgggggt ctgtccccag 2940 cataacgtgc tgtttgacat gctgactgtc gaagaacaca tctggttcta tgcccgcttg 3000 aaagggctct ctgagaagca cgtgaaggcg gagatggagc agatggccct ggatgttggt 3060 ttgccatcaa gcaagctgaa aagcaaaaca agccagctgt caggtggaat gcagagaaag 3120 ctatctgtgg ccttggcctt tgtcggggga tctaaggttg tcattctgga tgaacccaca 3180 gctggtgtgg acccttactc ccgcagggga atatgggagc tgctgctgaa ataccgacaa 3240 ggccgcacca ttattctctc tacacaccac atggatgaag cggacgtcct gggggacagg 3300 attgccatca tctcccatgg gaagctgtgc tgtgtgggct cctccctgtt tctgaagaac 3360 cagctgggaa caggctacta cctgaccttg gtcaagaaag atgtggaatc ctccctcagt 3420 tcctgcagaa acagtagtag cactgtgtca tacctgaaaa aggaggacag tgtttctcag 3480 agcagttctg atgctggcct gggcagcgac catgagagtg acacgctgac catcgatgtc 3540 tctgctatct ccaacctcat caggaagcat gtgtctgaag cccggctggt ggaagacata 3600 gggcatgagc tgacctatgt gctgccatat gaagctgcta aggagggagc ctttgtggaa 3660 ctctttcatg agattgatga ccggctctca gacctgggca tttctagtta tggcatctca 3720 gagacgaccc tggaagaaat attcctcaag gtggccgaag agagtggggt ggatgctgag 3780 acctcagatg gtaccttgcc agcaagacga aacaggcggg ccttcgggga caagcagagc 3840 tgtcttcgcc cgttcactga agatgatgct gctgatccaa atgattctga catagaccca 3900 gaatccagag agacagactt gctcagtggg atggatggca aagggtccta ccaggtgaaa 3960 ggctggaaac ttacacagca acagtttgtg gcccttttgt ggaagagact gctaattgcc 4020 agacggagtc ggaaaggatt ttttgctcag attgtcttgc cagctgtgtt tgtctgcatt 4080 gcccttgtgt tcagcctgat cgtgccaccc tttggcaagt accccagcct ggaacttcag 4140 ccctggatgt acaacgaaca gtacacattt gtcagcaatg atgctcctga ggacacggga 4200 accctggaac tcttaaacgc cctcaccaaa gaccctggct tcgggacccg ctgtatggaa 4260 ggaaacccaa tcccagacac gccctgccag gcaggggagg aagagtggac cactgcccca 4320 gttccccaga ccatcatgga cctcttccag aatgggaact ggacaatgca gaacccttca 4380 cctgcatgcc agtgtagcag cgacaaaatc aagaagatgc tgcctgtgtg tcccccaggg 4440 gcaggggggc tgcctcctcc acaaagaaaa caaaacactg cagatatcct tcaggacctg 4500 acaggaagaa acatttcgga ttatctggtg aagacgtatg tgcagatcat agccaaaagc 4560 ttaaagaaca agatctgggt gaatgagttt aggtatggcg gcttttccct gggtgtcagt 4620 aatactcaag cacttcctcc gagtcaagaa gttaatgatg ccatcaaaca aatgaagaaa 4680 cacctaaagc tggccaagga cagttctgca gatcgatttc tcaacagctt gggaagattt 4740 atgacaggac tggacaccaa aaataatgtc aaggtgtggt tcaataacaa gggctggcat 4800 gcaatcagct ctttcctgaa tgtcatcaac aatgccattc tccgggccaa cctgcaaaag 4860 ggagagaacc ctagccatta tggaattact gctttcaatc atcccctgaa tctcaccaag 4920 cagcagctct cagaggtggc tctgatgacc acatcagtgg atgtccttgt gtccatctgt 4980 gtcatctttg caatgtcctt cgtcccagcc agctttgtcg tattcctgat ccaggagcgg 5040 gtcagcaaag caaaacacct gcagttcatc agtggagtga agcctgtcat ctactggctc 5100 tctaattttg tctgggatat gtgcaattac gttgtccctg ccacactggt cattatcatc 5160 ttcatctgct tccagcagaa gtcctatgtg tcctccacca atctgcctgt gctagccctt 5220 ctacttttgc tgtatgggtg gtcaatcaca cctctcatgt acccagcctc ctttgtgttc 5280 aagatcccca gcacagccta tgtggtgctc accagcgtga acctcttcat tggcattaat 5340 ggcagcgtgg ccacctttgt gctggagctg ttcaccgaca ataagctgaa taatatcaat 5400 gatatcctga agtccgtgtt cttgatcttc ccacattttt gcctgggacg agggctcatc 5460 gacatggtga aaaaccaggc aatggctgat gccctggaaa ggtttgggga gaatcgcttt 5520 gtgtcaccat tatcttggga cttggtggga cgaaacctct tcgccatggc cgtggaaggg 5580 gtggtgttct tcctcattac tgttctgatc cagtacagat tcttcatcag gcccagacct 5640 gtaaatgcaa agctatctcc tctgaatgat gaagatgaag atgtgaggcg ggaaagacag 5700 agaattcttg atggtggagg ccagaatgac atcttagaaa tcaaggagtt gacgaagata 5760 tatagaagga agcggaagcc tgctgttgac aggatttgcg tgggcattcc tcctggtgag 5820 tgctttgggc tcctgggagt taatggggct ggaaaatcat caactttcaa gatgttaaca 5880 ggagatacca ctgttaccag aggagatgct ttccttaaca aaaatagtat cttatcaaac 5940 atccatgaag tacatcagaa catgggctac tgccctcagt ttgatgccat cacagagctg 6000 ttgactggga gagaacacgt ggagttcttt gcccttttga gaggagtccc agagaaagaa 6060 gttggcaagg ttggtgagtg ggcgattcgg aaactgggcc tcgtgaagta tggagaaaaa 6120 tatgctggta actatagtgg aggcaacaaa cgcaagctct ctacagccat ggctttgatc 6180 ggcgggcctc ctgtggtgtt tctggatgaa cccaccacag gcatggatcc caaagcccgg 6240 cggttcttgt ggaattgtgc cctaagtgtt gtcaaggagg ggagatcagt agtgcttaca 6300 tctcatagta tggaagagtg tgaagctctt tgcactagga tggcaatcat ggtcaatgga 6360 aggttcaggt gccttggcag tgtccagcat ctaaaaaata ggtttggaga tggttataca 6420 atagttgtac gaatagcagg gtccaacccg gacctgaagc ctgtccagga tttctttgga 6480 cttgcatttc ctggaagtgt tctaaaagag aaacaccgga acatgctaca ataccagctt 6540 ccatcttcat tatcttctct ggccaggata ttcagcatcc tctcccagag caaaaagcga 6600 ctccacatag aagactactc tgtttctcag acaacacttg accaagtatt tgtgaacttt 6660 gccaaggacc aaagtgatga tgaccactta aaagacctct cattacacaa aaaccagaca 6720 gtagtggacg ttgcagttct cacatctttt ctacaggatg agaaagtgaa agaaagctat 6780 gtatga 6786 9 2261 PRT Human 9 Met Ala Cys Trp Pro Gln Leu Arg Leu Leu Leu Trp Lys Asn Leu Thr 1 5 10 15 Phe Arg Arg Arg Gln Thr Cys Gln Leu Leu Leu Glu Val Ala Trp Pro 20 25 30 Leu Phe Ile Phe Leu Ile Leu Ile Ser Val Arg Leu Ser Tyr Pro Pro 35 40 45 Tyr Glu Gln His Glu Cys His Phe Pro Asn Lys Ala Met Pro Ser Ala 50 55 60 Gly Thr Leu Pro Trp Val Gln Gly Ile Ile Cys Asn Ala Asn Asn Pro 65 70 75 80 Cys Phe Arg Tyr Pro Thr Pro Gly Glu Ala Pro Gly Val Val Gly Asn 85 90 95 Phe Asn Lys Ser Ile Val Ala Arg Leu Phe Ser Asp Ala Arg Arg Leu 100 105 110 Leu Leu Tyr Ser Gln Lys Asp Thr Ser Met Lys Asp Met Arg Lys Val 115 120 125 Leu Arg Thr Leu Gln Gln Ile Lys Lys Ser Ser Ser Asn Leu Lys Leu 130 135 140 Gln Asp Phe Leu Val Asp Asn Glu Thr Phe Ser Gly Phe Leu Tyr His 145 150 155 160 Asn Leu Ser Leu Pro Lys Ser Thr Val Asp Lys Met Leu Arg Ala Asp 165 170 175 Val Ile Leu His Lys Val Phe Leu Gln Gly Tyr Gln Leu His Leu Thr 180 185 190 Ser Leu Cys Asn Gly Ser Lys Ser Glu Glu Met Ile Gln Leu Gly Asp 195 200 205 Gln Glu Val Ser Glu Leu Cys Gly Leu Pro Arg Glu Lys Leu Ala Ala 210 215 220 Ala Glu Arg Val Leu Arg Ser Asn Met Asp Ile Leu Lys Pro Ile Leu 225 230 235 240 Arg Thr Leu Asn Ser Thr Ser Pro Phe Pro Ser Lys Glu Leu Ala Glu 245 250 255 Ala Thr Lys Thr Leu Leu His Ser Leu Gly Thr Leu Ala Gln Glu Leu 260 265 270 Phe Ser Met Arg Ser Trp Ser Asp Met Arg Gln Glu Val Met Phe Leu 275 280 285 Thr Asn Val Asn Ser Ser Ser Ser Ser Thr Gln Ile Tyr Gln Ala Val 290 295 300 Ser Arg Ile Val Cys Gly His Pro Glu Gly Gly Gly Leu Lys Ile Lys 305 310 315 320 Ser Leu Asn Trp Tyr Glu Asp Asn Asn Tyr Lys Ala Leu Phe Gly Gly 325 330 335 Asn Gly Thr Glu Glu Asp Ala Glu Thr Phe Tyr Asp Asn Ser Thr Thr 340 345 350 Pro Tyr Cys Asn Asp Leu Met Lys Asn Leu Glu Ser Ser Pro Leu Ser 355 360 365 Arg Ile Ile Trp Lys Ala Leu Lys Pro Leu Leu Val Gly Lys Ile Leu 370 375 380 Tyr Thr Pro Asp Thr Pro Ala Thr Arg Gln Val Met Ala Glu Val Asn 385 390 395 400 Lys Thr Phe Gln Glu Leu Ala Val Phe His Asp Leu Glu Gly Met Trp 405 410 415 Glu Glu Leu Ser Pro Lys Ile Trp Thr Phe Met Glu Asn Ser Gln Glu 420 425 430 Met Asp Leu Val Arg Met Leu Leu Asp Ser Arg Asp Asn Asp His Phe 435 440 445 Trp Glu Gln Gln Leu Asp Gly Leu Asp Trp Thr Ala Gln Asp Ile Val 450 455 460 Ala Phe Leu Ala Lys His Pro Glu Asp Val Gln Ser Ser Asn Gly Ser 465 470 475 480 Val Tyr Thr Trp Arg Glu Ala Phe Asn Glu Thr Asn Gln Ala Ile Arg 485 490 495 Thr Ile Ser Arg Phe Met Glu Cys Val Asn Leu Asn Lys Leu Glu Pro 500 505 510 Ile Ala Thr Glu Val Trp Leu Ile Asn Lys Ser Met Glu Leu Leu Asp 515 520 525 Glu Arg Lys Phe Trp Ala Gly Ile Val Phe Thr Gly Ile Thr Pro Gly 530 535 540 Ser Ile Glu Leu Pro His His Val Lys Tyr Lys Ile Arg Met Asp Ile 545 550 555 560 Asp Asn Val Glu Arg Thr Asn Lys Ile Lys Asp Gly Tyr Trp Asp Pro 565 570 575 Gly Pro Arg Ala Asp Pro Phe Glu Asp Met Arg Tyr Val Trp Gly Gly 580 585 590 Phe Ala Tyr Leu Gln Asp Val Val Glu Gln Ala Ile Ile Arg Val Leu 595 600 605 Thr Gly Thr Glu Lys Lys Thr Gly Val Tyr Met Gln Gln Met Pro Tyr 610 615 620 Pro Cys Tyr Val Asp Asp Ile Phe Leu Arg Val Met Ser Arg Ser Met 625 630 635 640 Pro Leu Phe Met Thr Leu Ala Trp Ile Tyr Ser Val Ala Val Ile Ile 645 650 655 Lys Gly Ile Val Tyr Glu Lys Glu Ala Arg Leu Lys Glu Thr Met Arg 660 665 670 Ile Met Gly Leu Asp Asn Ser Ile Leu Trp Phe Ser Trp Phe Ile Ser 675 680 685 Ser Leu Ile Pro Leu Leu Val Ser Ala Gly Leu Leu Val Val Ile Leu 690 695 700 Lys Leu Gly Asn Leu Leu Pro Tyr Ser Asp Pro Ser Val Val Phe Val 705 710 715 720 Phe Leu Ser Val Phe Ala Val Val Thr Ile Leu Gln Cys Phe Leu Ile 725 730 735 Ser Thr Leu Phe Ser Arg Ala Asn Leu Ala Ala Ala Cys Gly Gly Ile 740 745 750 Ile Tyr Phe Thr Leu Tyr Leu Pro Tyr Val Leu Cys Val Ala Trp Gln 755 760 765 Asp Tyr Val Gly Phe Thr Leu Lys Ile Phe Ala Ser Leu Leu Ser Pro 770 775 780 Val Ala Phe Gly Phe Gly Cys Glu Tyr Phe Ala Leu Phe Glu Glu Gln 785 790 795 800 Gly Ile Gly Val Gln Trp Asp Asn Leu Phe Glu Ser Pro Val Glu Glu 805 810 815 Asp Gly Phe Asn Leu Thr Thr Ser Val Ser Met Met Leu Phe Asp Thr 820 825 830 Phe Leu Tyr Gly Val Met Thr Trp Tyr Ile Glu Ala Val Phe Pro Gly 835 840 845 Gln Tyr Gly Ile Pro Arg Pro Trp Tyr Phe Pro Cys Thr Lys Ser Tyr 850 855 860 Trp Phe Gly Glu Glu Ser Asp Glu Lys Ser His Pro Gly Ser Asn Gln 865 870 875 880 Lys Arg Ile Ser Glu Ile Cys Met Glu Glu Glu Pro Thr His Leu Lys 885 890 895 Leu Gly Val Ser Ile Gln Asn Leu Val Lys Val Tyr Arg Asp Gly Met 900 905 910 Lys Val Ala Val Asp Gly Leu Ala Leu Asn Phe Tyr Glu Gly Gln Ile 915 920 925 Thr Ser Phe Leu Gly His Asn Gly Ala Gly Lys Thr Thr Thr Met Ser 930 935 940 Ile Leu Thr Gly Leu Phe Pro Pro Thr Ser Gly Thr Ala Tyr Ile Leu 945 950 955 960 Gly Lys Asp Ile Arg Ser Glu Met Ser Thr Ile Arg Gln Asn Leu Gly 965 970 975 Val Cys Pro Gln His Asn Val Leu Phe Asp Met Leu Thr Val Glu Glu 980 985 990 His Ile Trp Phe Tyr Ala Arg Leu Lys Gly Leu Ser Glu Lys His Val 995 1000 1005 Lys Ala Glu Met Glu Gln Met Ala Leu Asp Val Gly Leu Pro Ser 1010 1015 1020 Ser Lys Leu Lys Ser Lys Thr Ser Gln Leu Ser Gly Gly Met Gln 1025 1030 1035 Arg Lys Leu Ser Val Ala Leu Ala Phe Val Gly Gly Ser Lys Val 1040 1045 1050 Val Ile Leu Asp Glu Pro Thr Ala Gly Val Asp Pro Tyr Ser Arg 1055 1060 1065 Arg Gly Ile Trp Glu Leu Leu Leu Lys Tyr Arg Gln Gly Arg Thr 1070 1075 1080 Ile Ile Leu Ser Thr His His Met Asp Glu Ala Asp Val Leu Gly 1085 1090 1095 Asp Arg Ile Ala Ile Ile Ser His Gly Lys Leu Cys Cys Val Gly 1100 1105 1110 Ser Ser Leu Phe Leu Lys Asn Gln Leu Gly Thr Gly Tyr Tyr Leu 1115 1120 1125 Thr Leu Val Lys Lys Asp Val Glu Ser Ser Leu Ser Ser Cys Arg 1130 1135 1140 Asn Ser Ser Ser Thr Val Ser Tyr Leu Lys Lys Glu Asp Ser Val 1145 1150 1155 Ser Gln Ser Ser Ser Asp Ala Gly Leu Gly Ser Asp His Glu Ser 1160 1165 1170 Asp Thr Leu Thr Ile Asp Val Ser Ala Ile Ser Asn Leu Ile Arg 1175 1180 1185 Lys His Val Ser Glu Ala Arg Leu Val Glu Asp Ile Gly His Glu 1190 1195 1200 Leu Thr Tyr Val Leu Pro Tyr Glu Ala Ala Lys Glu Gly Ala Phe 1205 1210 1215 Val Glu Leu Phe His Glu Ile Asp Asp Arg Leu Ser Asp Leu Gly 1220 1225 1230 Ile Ser Ser Tyr Gly Ile Ser Glu Thr Thr Leu Glu Glu Ile Phe 1235 1240 1245 Leu Lys Val Ala Glu Glu Ser Gly Val Asp Ala Glu Thr Ser Asp 1250 1255 1260 Gly Thr Leu Pro Ala Arg Arg Asn Arg Arg Ala Phe Gly Asp Lys 1265 1270 1275 Gln Ser Cys Leu Arg Pro Phe Thr Glu Asp Asp Ala Ala Asp Pro 1280 1285 1290 Asn Asp Ser Asp Ile Asp Pro Glu Ser Arg Glu Thr Asp Leu Leu 1295 1300 1305 Ser Gly Met Asp Gly Lys Gly Ser Tyr Gln Val Lys Gly Trp Lys 1310 1315 1320 Leu Thr Gln Gln Gln Phe Val Ala Leu Leu Trp Lys Arg Leu Leu 1325 1330 1335 Ile Ala Arg Arg Ser Arg Lys Gly Phe Phe Ala Gln Ile Val Leu 1340 1345 1350 Pro Ala Val Phe Val Cys Ile Ala Leu Val Phe Ser Leu Ile Val 1355 1360 1365 Pro Pro Phe Gly Lys Tyr Pro Ser Leu Glu Leu Gln Pro Trp Met 1370 1375 1380 Tyr Asn Glu Gln Tyr Thr Phe Val Ser Asn Asp Ala Pro Glu Asp 1385 1390 1395 Thr Gly Thr Leu Glu Leu Leu Asn Ala Leu Thr Lys Asp Pro Gly 1400 1405 1410 Phe Gly Thr Arg Cys Met Glu Gly Asn Pro Ile Pro Asp Thr Pro 1415 1420 1425 Cys Gln Ala Gly Glu Glu Glu Trp Thr Thr Ala Pro Val Pro Gln 1430 1435 1440 Thr Ile Met Asp Leu Phe Gln Asn Gly Asn Trp Thr Met Gln Asn 1445 1450 1455 Pro Ser Pro Ala Cys Gln Cys Ser Ser Asp Lys Ile Lys Lys Met 1460 1465 1470 Leu Pro Val Cys Pro Pro Gly Ala Gly Gly Leu Pro Pro Pro Gln 1475 1480 1485 Arg Lys Gln Asn Thr Ala Asp Ile Leu Gln Asp Leu Thr Gly Arg 1490 1495 1500 Asn Ile Ser Asp Tyr Leu Val Lys Thr Tyr Val Gln Ile Ile Ala 1505 1510 1515 Lys Ser Leu Lys Asn Lys Ile Trp Val Asn Glu Phe Arg Tyr Gly 1520 1525 1530 Gly Phe Ser Leu Gly Val Ser Asn Thr Gln Ala Leu Pro Pro Ser 1535 1540 1545 Gln Glu Val Asn Asp Ala Ile Lys Gln Met Lys Lys His Leu Lys 1550 1555 1560 Leu Ala Lys Asp Ser Ser Ala Asp Arg Phe Leu Asn Ser Leu Gly 1565 1570 1575 Arg Phe Met Thr Gly Leu Asp Thr Lys Asn Asn Val Lys Val Trp 1580 1585 1590 Phe Asn Asn Lys Gly Trp His Ala Ile Ser Ser Phe Leu Asn Val 1595 1600 1605 Ile Asn Asn Ala Ile Leu Arg Ala Asn Leu Gln Lys Gly Glu Asn 1610 1615 1620 Pro Ser His Tyr Gly Ile Thr Ala Phe Asn His Pro Leu Asn Leu 1625 1630 1635 Thr Lys Gln Gln Leu Ser Glu Val Ala Leu Met Thr Thr Ser Val 1640 1645 1650 Asp Val Leu Val Ser Ile Cys Val Ile Phe Ala Met Ser Phe Val 1655 1660 1665 Pro Ala Ser Phe Val Val Phe Leu Ile Gln Glu Arg Val Ser Lys 1670 1675 1680 Ala Lys His Leu Gln Phe Ile Ser Gly Val Lys Pro Val Ile Tyr 1685 1690 1695 Trp Leu Ser Asn Phe Val Trp Asp Met Cys Asn Tyr Val Val Pro 1700 1705 1710 Ala Thr Leu Val Ile Ile Ile Phe Ile Cys Phe Gln Gln Lys Ser 1715 1720 1725 Tyr Val Ser Ser Thr Asn Leu Pro Val Leu Ala Leu Leu Leu Leu 1730 1735 1740 Leu Tyr Gly Trp Ser Ile Thr Pro Leu Met Tyr Pro Ala Ser Phe 1745 1750 1755 Val Phe Lys Ile Pro Ser Thr Ala Tyr Val Val Leu Thr Ser Val 1760 1765 1770 Asn Leu Phe Ile Gly Ile Asn Gly Ser Val Ala Thr Phe Val Leu 1775 1780 1785 Glu Leu Phe Thr Asp Asn Lys Leu Asn Asn Ile Asn Asp Ile Leu 1790 1795 1800 Lys Ser Val Phe Leu Ile Phe Pro His Phe Cys Leu Gly Arg Gly 1805 1810 1815 Leu Ile Asp Met Val Lys Asn Gln Ala Met Ala Asp Ala Leu Glu 1820 1825 1830 Arg Phe Gly Glu Asn Arg Phe Val Ser Pro Leu Ser Trp Asp Leu 1835 1840 1845 Val Gly Arg Asn Leu Phe Ala Met Ala Val Glu Gly Val Val Phe 1850 1855 1860 Phe Leu Ile Thr Val Leu Ile Gln Tyr Arg Phe Phe Ile Arg Pro 1865 1870 1875 Arg Pro Val Asn Ala Lys Leu Ser Pro Leu Asn Asp Glu Asp Glu 1880 1885 1890 Asp Val Arg Arg Glu Arg Gln Arg Ile Leu Asp Gly Gly Gly Gln 1895 1900 1905 Asn Asp Ile Leu Glu Ile Lys Glu Leu Thr Lys Ile Tyr Arg Arg 1910 1915 1920 Lys Arg Lys Pro Ala Val Asp Arg Ile Cys Val Gly Ile Pro Pro 1925 1930 1935 Gly Glu Cys Phe Gly Leu Leu Gly Val Asn Gly Ala Gly Lys Ser 1940 1945 1950 Ser Thr Phe Lys Met Leu Thr Gly Asp Thr Thr Val Thr Arg Gly 1955 1960 1965 Asp Ala Phe Leu Asn Lys Asn Ser Ile Leu Ser Asn Ile His Glu 1970 1975 1980 Val His Gln Asn Met Gly Tyr Cys Pro Gln Phe Asp Ala Ile Thr 1985 1990 1995 Glu Leu Leu Thr Gly Arg Glu His Val Glu Phe Phe Ala Leu Leu 2000 2005 2010 Arg Gly Val Pro Glu Lys Glu Val Gly Lys Val Gly Glu Trp Ala 2015 2020 2025 Ile Arg Lys Leu Gly Leu Val Lys Tyr Gly Glu Lys Tyr Ala Gly 2030 2035 2040 Asn Tyr Ser Gly Gly Asn Lys Arg Lys Leu Ser Thr Ala Met Ala 2045 2050 2055 Leu Ile Gly Gly Pro Pro Val Val Phe Leu Asp Glu Pro Thr Thr 2060 2065 2070 Gly Met Asp Pro Lys Ala Arg Arg Phe Leu Trp Asn Cys Ala Leu 2075 2080 2085 Ser Val Val Lys Glu Gly Arg Ser Val Val Leu Thr Ser His Ser 2090 2095 2100 Met Glu Glu Cys Glu Ala Leu Cys Thr Arg Met Ala Ile Met Val 2105 2110 2115 Asn Gly Arg Phe Arg Cys Leu Gly Ser Val Gln His Leu Lys Asn 2120 2125 2130 Arg Phe Gly Asp Gly Tyr Thr Ile Val Val Arg Ile Ala Gly Ser 2135 2140 2145 Asn Pro Asp Leu Lys Pro Val Gln Asp Phe Phe Gly Leu Ala Phe 2150 2155 2160 Pro Gly Ser Val Leu Lys Glu Lys His Arg Asn Met Leu Gln Tyr 2165 2170 2175 Gln Leu Pro Ser Ser Leu Ser Ser Leu Ala Arg Ile Phe Ser Ile 2180 2185 2190 Leu Ser Gln Ser Lys Lys Arg Leu His Ile Glu Asp Tyr Ser Val 2195 2200 2205 Ser Gln Thr Thr Leu Asp Gln Val Phe Val Asn Phe Ala Lys Asp 2210 2215 2220 Gln Ser Asp Asp Asp His Leu Lys Asp Leu Ser Leu His Lys Asn 2225 2230 2235 Gln Thr Val Val Asp Val Ala Val Leu Thr Ser Phe Leu Gln Asp 2240 2245 2250 Glu Lys Val Lys Glu Ser Tyr Val 2255 2260 10 2261 PRT Human 10 Met Ala Cys Trp Pro Gln Leu Arg Leu Leu Leu Trp Lys Asn Leu Thr 1 5 10 15 Phe Arg Arg Arg Gln Thr Cys Gln Leu Leu Leu Glu Val Ala Trp Pro 20 25 30 Leu Phe Ile Phe Leu Ile Leu Ile Ser Val Arg Leu Ser Tyr Pro Pro 35 40 45 Tyr Glu Gln His Glu Cys His Phe Pro Asn Lys Ala Met Pro Ser Ala 50 55 60 Gly Thr Leu Pro Trp Val Gln Gly Ile Ile Cys Asn Ala Asn Asn Pro 65 70 75 80 Cys Phe Arg Tyr Pro Thr Pro Gly Glu Ala Pro Gly Val Val Gly Asn 85 90 95 Phe Asn Lys Ser Ile Val Ala Arg Leu Phe Ser Asp Ala Arg Arg Leu 100 105 110 Leu Leu Tyr Ser Gln Lys Asp Thr Ser Met Lys Asp Met Arg Lys Val 115 120 125 Leu Arg Thr Leu Gln Gln Ile Lys Lys Ser Ser Ser Asn Leu Lys Leu 130 135 140 Gln Asp Phe Leu Val Asp Asn Glu Thr Phe Ser Gly Phe Leu Tyr His 145 150 155 160 Asn Leu Ser Leu Pro Lys Ser Thr Val Asp Lys Met Leu Arg Ala Asp 165 170 175 Val Ile Leu His Lys Val Phe Leu Gln Gly Tyr Gln Leu His Leu Thr 180 185 190 Ser Leu Cys Asn Gly Ser Lys Ser Glu Glu Met Ile Gln Leu Gly Asp 195 200 205 Gln Glu Val Ser Glu Leu Cys Gly Leu Pro Arg Glu Lys Leu Ala Ala 210 215 220 Ala Glu Arg Val Leu Arg Ser Asn Met Asp Ile Leu Lys Pro Ile Leu 225 230 235 240 Arg Thr Leu Asn Ser Thr Ser Pro Phe Pro Ser Lys Glu Leu Ala Glu 245 250 255 Ala Thr Lys Thr Leu Leu His Ser Leu Gly Thr Leu Ala Gln Glu Leu 260 265 270 Phe Ser Met Arg Ser Trp Ser Asp Met Arg Gln Glu Val Met Phe Leu 275 280 285 Thr Asn Val Asn Ser Ser Ser Ser Ser Thr Gln Ile Tyr Gln Ala Val 290 295 300 Ser Arg Ile Val Cys Gly His Pro Glu Gly Gly Gly Leu Lys Ile Lys 305 310 315 320 Ser Leu Asn Trp Tyr Glu Asp Asn Asn Tyr Lys Ala Leu Phe Gly Gly 325 330 335 Asn Gly Thr Glu Glu Asp Ala Glu Thr Phe Tyr Asp Asn Ser Thr Thr 340 345 350 Pro Tyr Cys Asn Asp Leu Met Lys Asn Leu Glu Ser Ser Pro Leu Ser 355 360 365 Arg Ile Ile Trp Lys Ala Leu Lys Pro Leu Leu Val Gly Lys Ile Leu 370 375 380 Tyr Thr Pro Asp Thr Pro Ala Thr Arg Gln Val Met Ala Glu Val Asn 385 390 395 400 Lys Thr Phe Gln Glu Leu Ala Val Phe His Asp Leu Glu Gly Met Trp 405 410 415 Glu Glu Leu Ser Pro Lys Ile Trp Thr Phe Met Glu Asn Ser Gln Glu 420 425 430 Met Asp Leu Val Arg Met Leu Leu Asp Ser Arg Asp Asn Asp His Phe 435 440 445 Trp Glu Gln Gln Leu Asp Gly Leu Asp Trp Thr Ala Gln Asp Ile Val 450 455 460 Ala Phe Leu Ala Lys His Pro Glu Asp Val Gln Ser Ser Asn Gly Ser 465 470 475 480 Val Tyr Thr Trp Arg Glu Ala Phe Asn Glu Thr Asn Gln Ala Ile Arg 485 490 495 Thr Ile Ser Arg Phe Met Glu Cys Val Asn Leu Asn Lys Leu Glu Pro 500 505 510 Ile Ala Thr Glu Val Trp Leu Ile Asn Lys Ser Met Glu Leu Leu Asp 515 520 525 Glu Arg Lys Phe Trp Ala Gly Ile Val Phe Thr Gly Ile Thr Pro Gly 530 535 540 Ser Ile Glu Leu Pro His His Val Lys Tyr Lys Ile Arg Met Asp Ile 545 550 555 560 Asp Asn Val Glu Arg Thr Asn Lys Ile Lys Asp Gly Tyr Trp Asp Pro 565 570 575 Gly Pro Arg Ala Asp Pro Phe Glu Asp Met Arg Tyr Val Trp Gly Gly 580 585 590 Phe Ala Tyr Leu Gln Asp Val Val Glu Gln Ala Ile Ile Arg Val Leu 595 600 605 Thr Gly Thr Glu Lys Lys Thr Gly Val Tyr Met Gln Gln Met Pro Tyr 610 615 620 Pro Cys Tyr Val Asp Asp Ile Phe Leu Arg Val Met Ser Arg Ser Met 625 630 635 640 Pro Leu Phe Met Thr Leu Ala Trp Ile Tyr Ser Val Ala Val Ile Ile 645 650 655 Lys Gly Ile Val Tyr Glu Lys Glu Ala Arg Leu Lys Glu Thr Met Arg 660 665 670 Ile Met Gly Leu Asp Asn Ser Ile Leu Trp Phe Ser Trp Phe Ile Ser 675 680 685 Ser Leu Ile Pro Leu Leu Val Ser Ala Gly Leu Leu Val Val Ile Leu 690 695 700 Lys Leu Gly Asn Leu Leu Pro Tyr Ser Asp Pro Ser Val Val Phe Val 705 710 715 720 Phe Leu Ser Val Phe Ala Val Val Thr Ile Leu Gln Cys Phe Leu Ile 725 730 735 Ser Thr Leu Phe Ser Arg Ala Asn Leu Ala Ala Ala Cys Gly Gly Ile 740 745 750 Ile Tyr Phe Thr Leu Tyr Leu Pro Tyr Val Leu Cys Val Ala Trp Gln 755 760 765 Asp Tyr Val Gly Phe Thr Leu Lys Ile Phe Ala Ser Leu Leu Ser Pro 770 775 780 Val Ala Phe Gly Phe Gly Cys Glu Tyr Phe Ala Leu Phe Glu Glu Gln 785 790 795 800 Gly Ile Gly Val Gln Trp Asp Asn Leu Phe Glu Ser Pro Val Glu Glu 805 810 815 Asp Gly Phe Asn Leu Thr Thr Ser Val Ser Met Met Leu Phe Asp Thr 820 825 830 Phe Leu Tyr Gly Val Met Thr Trp Tyr Ile Glu Ala Val Phe Pro Gly 835 840 845 Gln Tyr Gly Ile Pro Arg Pro Trp Tyr Phe Pro Cys Thr Lys Ser Tyr 850 855 860 Trp Phe Gly Glu Glu Ser Asp Glu Lys Ser His Pro Gly Ser Asn Gln 865 870 875 880 Lys Arg Ile Ser Glu Ile Cys Met Glu Glu Glu Pro Thr His Leu Lys 885 890 895 Leu Gly Val Ser Ile Gln Asn Leu Val Lys Val Tyr Arg Asp Gly Met 900 905 910 Lys Val Ala Val Asp Gly Leu Ala Leu Asn Phe Tyr Glu Gly Gln Ile 915 920 925 Thr Ser Phe Leu Gly His Asn Gly Ala Gly Lys Thr Thr Thr Met Ser 930 935 940 Ile Leu Thr Gly Leu Phe Pro Pro Thr Ser Gly Thr Ala Tyr Ile Leu 945 950 955 960 Gly Lys Asp Ile Arg Ser Glu Met Ser Thr Ile Arg Gln Asn Leu Gly 965 970 975 Val Cys Pro Gln His Asn Val Leu Phe Asp Met Leu Thr Val Glu Glu 980 985 990 His Ile Trp Phe Tyr Ala Arg Leu Lys Gly Leu Ser Glu Lys His Val 995 1000 1005 Lys Ala Glu Met Glu Gln Met Ala Leu Asp Val Gly Leu Pro Ser 1010 1015 1020 Ser Lys Leu Lys Ser Lys Thr Ser Gln Leu Ser Gly Gly Met Gln 1025 1030 1035 Arg Lys Leu Ser Val Ala Leu Ala Phe Val Gly Gly Ser Lys Val 1040 1045 1050 Val Ile Leu Asp Glu Pro Thr Ala Gly Val Asp Pro Tyr Ser Arg 1055 1060 1065 Arg Gly Ile Trp Glu Leu Leu Leu Lys Tyr Arg Gln Gly Arg Thr 1070 1075 1080 Ile Ile Leu Ser Thr His His Met Asp Glu Ala Asp Val Leu Gly 1085 1090 1095 Asp Arg Ile Ala Ile Ile Ser His Gly Lys Leu Cys Cys Val Gly 1100 1105 1110 Ser Ser Leu Phe Leu Lys Asn Gln Leu Gly Thr Gly Tyr Tyr Leu 1115 1120 1125 Thr Leu Val Lys Lys Asp Val Glu Ser Ser Leu Ser Ser Cys Arg 1130 1135 1140 Asn Ser Ser Ser Thr Val Ser Tyr Leu Lys Lys Glu Asp Ser Val 1145 1150 1155 Ser Gln Ser Ser Ser Asp Ala Gly Leu Gly Ser Asp His Glu Ser 1160 1165 1170 Asp Thr Leu Thr Ile Asp Val Ser Ala Ile Ser Asn Leu Ile Arg 1175 1180 1185 Lys His Val Ser Glu Ala Arg Leu Val Glu Asp Ile Gly His Glu 1190 1195 1200 Leu Thr Tyr Val Leu Pro Tyr Glu Ala Ala Lys Glu Gly Ala Phe 1205 1210 1215 Val Glu Leu Phe His Glu Ile Asp Asp Arg Leu Ser Asp Leu Gly 1220 1225 1230 Ile Ser Ser Tyr Gly Ile Ser Glu Thr Thr Leu Glu Glu Ile Phe 1235 1240 1245 Leu Lys Val Ala Glu Glu Ser Gly Val Asp Ala Glu Thr Ser Asp 1250 1255 1260 Gly Thr Leu Pro Ala Arg Arg Asn Arg Arg Ala Phe Gly Asp Lys 1265 1270 1275 Gln Ser Cys Leu Arg Pro Phe Thr Glu Asp Asp Ala Ala Asp Pro 1280 1285 1290 Asn Asp Ser Asp Ile Asp Pro Glu Ser Arg Glu Thr Asp Leu Leu 1295 1300 1305 Ser Gly Met Asp Gly Lys Gly Ser Tyr Gln Val Lys Gly Trp Lys 1310 1315 1320 Leu Thr Gln Gln Gln Phe Val Ala Leu Leu Trp Lys Arg Leu Leu 1325 1330 1335 Ile Ala Arg Arg Ser Arg Lys Gly Phe Phe Ala Gln Ile Val Leu 1340 1345 1350 Pro Ala Val Phe Val Cys Ile Ala Leu Val Phe Ser Leu Ile Val 1355 1360 1365 Pro Pro Phe Gly Lys Tyr Pro Ser Leu Glu Leu Gln Pro Trp Met 1370 1375 1380 Tyr Asn Glu Gln Tyr Thr Phe Val Ser Asn Asp Ala Pro Glu Asp 1385 1390 1395 Thr Gly Thr Leu Glu Leu Leu Asn Ala Leu Thr Lys Asp Pro Gly 1400 1405 1410 Phe Gly Thr Arg Cys Met Glu Gly Asn Pro Ile Pro Asp Thr Pro 1415 1420 1425 Cys Gln Ala Gly Glu Glu Glu Trp Thr Thr Ala Pro Val Pro Gln 1430 1435 1440 Thr Ile Met Asp Leu Phe Gln Asn Gly Asn Trp Thr Met Gln Asn 1445 1450 1455 Pro Ser Pro Ala Cys Gln Cys Ser Ser Asp Lys Ile Lys Lys Met 1460 1465 1470 Leu Pro Val Cys Pro Pro Gly Ala Gly Gly Leu Pro Pro Pro Gln 1475 1480 1485 Arg Lys Gln Asn Thr Ala Asp Ile Leu Gln Asp Leu Thr Gly Arg 1490 1495 1500 Asn Ile Ser Asp Tyr Leu Val Lys Thr Tyr Val Gln Ile Ile Ala 1505 1510 1515 Lys Ser Leu Lys Asn Lys Ile Trp Val Asn Glu Phe Arg Tyr Gly 1520 1525 1530 Gly Phe Ser Leu Gly Val Ser Asn Thr Gln Ala Leu Pro Pro Ser 1535 1540 1545 Gln Glu Val Asn Asp Ala Ile Lys Gln Met Lys Lys His Leu Lys 1550 1555 1560 Leu Ala Lys Asp Ser Ser Ala Asp Arg Phe Leu Asn Ser Leu Gly 1565 1570 1575 Arg Phe Met Thr Gly Leu Asp Thr Lys Asn Asn Val Lys Val Trp 1580 1585 1590 Phe Asn Asn Lys Gly Trp His Ala Ile Ser Ser Phe Leu Asn Val 1595 1600 1605 Ile Asn Asn Ala Ile Leu Arg Ala Asn Leu Gln Lys Gly Glu Asn 1610 1615 1620 Pro Ser His Tyr Gly Ile Thr Ala Phe Asn His Pro Leu Asn Leu 1625 1630 1635 Thr Lys Gln Gln Leu Ser Glu Val Ala Leu Met Thr Thr Ser Val 1640 1645 1650 Asp Val Leu Val Ser Ile Cys Val Ile Phe Ala Met Ser Phe Val 1655 1660 1665 Pro Ala Ser Phe Val Val Phe Leu Ile Gln Glu Arg Val Ser Lys 1670 1675 1680 Ala Lys His Leu Gln Phe Ile Ser Gly Val Lys Pro Val Ile Tyr 1685 1690 1695 Trp Leu Ser Asn Phe Val Trp Asp Met Cys Asn Tyr Val Val Pro 1700 1705 1710 Ala Thr Leu Val Ile Ile Ile Phe Ile Cys Phe Gln Gln Lys Ser 1715 1720 1725 Tyr Val Ser Ser Thr Asn Leu Pro Val Leu Ala Leu Leu Leu Leu 1730 1735 1740 Leu Tyr Gly Trp Ser Ile Thr Pro Leu Met Tyr Pro Ala Ser Phe 1745 1750 1755 Val Phe Lys Ile Pro Ser Thr Ala Tyr Val Val Leu Thr Ser Val 1760 1765 1770 Asn Leu Phe Ile Gly Ile Asn Gly Ser Val Ala Thr Phe Val Leu 1775 1780 1785 Glu Leu Phe Thr Asp Asn Lys Leu Asn Asn Ile Asn Asp Ile Leu 1790 1795 1800 Lys Ser Val Phe Leu Ile Phe Pro His Phe Cys Leu Gly Arg Gly 1805 1810 1815 Leu Ile Asp Met Val Lys Asn Gln Ala Met Ala Asp Ala Leu Glu 1820 1825 1830 Arg Phe Gly Glu Asn Arg Phe Val Ser Pro Leu Ser Trp Asp Leu 1835 1840 1845 Val Gly Arg Asn Leu Phe Ala Met Ala Val Glu Gly Val Val Phe 1850 1855 1860 Phe Leu Ile Thr Val Leu Ile Gln Tyr Arg Phe Phe Ile Arg Pro 1865 1870 1875 Arg Pro Val Asn Ala Lys Leu Ser Pro Leu Asn Asp Glu Asp Glu 1880 1885 1890 Asp Val Arg Arg Glu Arg Gln Arg Ile Leu Asp Gly Gly Gly Gln 1895 1900 1905 Asn Asp Ile Leu Glu Ile Lys Glu Leu Thr Lys Ile Tyr Arg Arg 1910 1915 1920 Lys Arg Lys Pro Ala Val Asp Arg Ile Cys Val Gly Ile Pro Pro 1925 1930 1935 Gly Glu Cys Phe Gly Leu Leu Gly Val Asn Gly Ala Gly Lys Ser 1940 1945 1950 Ser Thr Phe Lys Met Leu Thr Gly Asp Thr Thr Val Thr Arg Gly 1955 1960 1965 Asp Ala Phe Leu Asn Lys Asn Ser Ile Leu Ser Asn Ile His Glu 1970 1975 1980 Val His Gln Asn Met Gly Tyr Cys Pro Gln Phe Asp Ala Ile Thr 1985 1990 1995 Glu Leu Leu Thr Gly Arg Glu His Val Glu Phe Phe Ala Leu Leu 2000 2005 2010 Arg Gly Val Pro Glu Lys Glu Val Gly Lys Val Gly Glu Trp Ala 2015 2020 2025 Ile Arg Lys Leu Gly Leu Val Lys Tyr Gly Glu Lys Tyr Ala Gly 2030 2035 2040 Asn Tyr Ser Gly Gly Asn Lys Arg Lys Leu Ser Thr Ala Met Ala 2045 2050 2055 Leu Ile Gly Gly Pro Pro Val Val Phe Leu Asp Glu Pro Thr Thr 2060 2065 2070 Gly Met Asp Pro Lys Ala Arg Arg Phe Leu Trp Asn Cys Ala Leu 2075 2080 2085 Ser Val Val Lys Glu Gly Arg Ser Val Val Leu Thr Ser His Ser 2090 2095 2100 Met Glu Glu Cys Glu Ala Leu Cys Thr Arg Met Ala Ile Met Val 2105 2110 2115 Asn Gly Arg Phe Arg Cys Leu Gly Ser Val Gln His Leu Lys Asn 2120 2125 2130 Arg Phe Gly Asp Gly Tyr Thr Ile Val Val Arg Ile Ala Gly Ser 2135 2140 2145 Asn Pro Asp Leu Lys Pro Val Gln Asp Phe Phe Gly Leu Ala Phe 2150 2155 2160 Pro Gly Ser Val Leu Lys Glu Lys His Arg Asn Met Leu Gln Tyr 2165 2170 2175 Gln Leu Pro Ser Ser Leu Ser Ser Leu Ala Arg Ile Phe Ser Ile 2180 2185 2190 Leu Ser Gln Ser Lys Lys Arg Leu His Ile Glu Asp Tyr Ser Val 2195 2200 2205 Ser Gln Thr Thr Leu Asp Gln Val Phe Val Asn Phe Ala Lys Asp 2210 2215 2220 Gln Ser Asp Asp Asp His Leu Lys Asp Leu Ser Leu His Lys Asn 2225 2230 2235 Gln Thr Val Val Asp Val Ala Val Leu Thr Ser Phe Leu Gln Asp 2240 2245 2250 Glu Lys Val Lys Glu Ser Tyr Val 2255 2260 11 2751 DNA Human 11 ggcacgaggc cggatccacc gtgcctctgc ggcctgcgtg cccggagtcc ccgcctgtgt 60 cgtctctgtc gccgtccccg tctcctgcca ggcgcggagc cctgcgagcc gcgggtgggc 120 cccaggcgcg cagacatggg ctgctccgcc aaagcgcgct gggctgccgg ggcgctgggc 180 gtcgcggggc tactgtgcgc tgtgctgggc gctgtcatga tcgtgatggt gccgtcgctc 240 atcaagcagc aggtccttaa gaacgtgcgc atcgacccca gtagcctgtc cttcaacatg 300 tggaaggaga tccctatccc cttctatctc tccgtctact tctttgacgt catgaacccc 360 agcgagatcc tgaagggcga gaagccgcag gtgcgggagc gcgggcccta cgtgtacagg 420 gagttcaggc acaaaagcaa catcaccttc aacaacaacg acaccgtgtc cttcctcgag 480 taccgcacct tccagttcca gccctccaag tcccacggct cggagagcga ctacatcgtc 540 atgcccaaca tcctggtctt gggtgcggcg gtgatgatgg agaataagcc catgaccctg 600 aagctcatca tgaccttggc attcaccacc ctcggcgaac gtgccttcat gaaccgcact 660 gtgggtgaga tcatgtgggg ctacaaggac ccccttgtga atctcatcaa caagtacttt 720 ccaggcatgt tccccttcaa ggacaagttc ggattatttg ctgagctcaa caactccgac 780 tctgggctct tcacggtgtt cacgggggtc cagaacatca gcaggatcca cctcgtggac 840 aagtggaacg ggctgagcaa ggttgacttc tggcattccg atcagtgcaa catgatcaat 900 ggaacttctg ggcaaatgtg gccgcccttc atgactcctg agtcctcgct ggagttctac 960 agcccggagg cctgccgatc catgaagcta atgtacaagg agtcaggggt gtttgaaggc 1020 atccccacct atcgcttcgt ggctcccaaa accctgtttg ccaacgggtc catctaccca 1080 cccaacgaag gcttctgccc gtgcctggag tctggaattc agaacgtcag cacctgcagg 1140 ttcagtgccc ccttgtttct ctcccatcct cacttcctca acgccgaccc ggttctggca 1200 gaagcggtga ctggcctgca ccctaaccag gaggcacact ccttgttcct ggacatccac 1260 ccggtcacgg gaatccccat gaactgctct gtgaaactgc agctgagcct ctacatgaaa 1320 tctgtcgcag gcattggaca aactgggaag attgagcctg tggtcctgcc gctgctctgg 1380 tttgcagaga gcggggccat ggagggggag actcttcaca cattctacac tcagctggtg 1440 ttgatgccca aggtgatgca ctatgcccag tacgtcctcc tggcgctggg ctgcgtcctg 1500 ctgctggtcc ctgtcatctg ccaaatccgg agccaagtag gtgctggcca gagggcagcc 1560 cgggctgaca gccattcgct tgcctgctgg gggaaagggg cctcagatcg gaccctctgg 1620 ccaaccgcag cctggagccc acctccagca gcagtcctgc gtctctgccg gagtgggagc 1680 ggtcactgct gggggctgcg cagcacgctt gcgtcttttg catgccgcgt tgccactact 1740 ctgcctgttc tggaaggcct gggaccctcc cttggagggg gcacagggtc ctgaggacac 1800 cgtgagccag ccaggcctgg ccgctgggcc tgaccggccc cccagcccct acaccccgct 1860 tctcccggac tctcccagcg gacagccccc cagccccaca gcctgagcct cccagctgcc 1920 atgtgcctgt tgcacacctg cacacacgcc ctggcacaca tacacacatg cgtgcaggct 1980 tgtgcagaca ctcagggatg gagctgctgc tgaagggact tgtagggaga ggctcgtcaa 2040 caagcactgt tctggaacct tctctccacg tggcccacag gcctgaccac aggggctgtg 2100 ggtcctgcgt ccccttcctc gggtgagcct ggcctgtccc gttcagccgt tgggcccagg 2160 cttcctcccc tccaaggtga aacactgcag tcccggtgtg gtggctcccc atgcaggacg 2220 ggccaggctg ggagtgccgc cttcctgtgc caaattcagt ggggactcag tgcccaggcc 2280 ctggccacga gctttggcct tggtctacct gccaggccag gcaaagcgcc tttacacagg 2340 cctcggaaaa caatggagtg agcacaagat gccctgtgca gctgcccgag ggtctccgcc 2400 caccccggcc ggactttgat ccccccgaag tcttcacagg cactgcatcg ggttgtctgg 2460 cgcccttttc ctccagccta aactgacatc atcctatgga ctgagccggc cactctctgg 2520 ccgaagtggc cgcaggctgt gcccccgagc tgcccccacc ccctcacagg gtccctcaga 2580 ttataggtgc ccaggctgag gtgaagaggc ctgggggccc tgccttccgg gcgctcctgg 2640 accctggggc aaacctgtga cccttttcta ctggaataga aatgagtttt atcatctttg 2700 aaaaataatt cactcttgaa gtaataaacg tttaaaaaaa aaaaaaaaaa a 2751 12 552 PRT Human 12 Met Gly Cys Ser Ala Lys Ala Arg Trp Ala Ala Gly Ala Leu Gly Val 1 5 10 15 Ala Gly Leu Leu Cys Ala Val Leu Gly Ala Val Met Ile Val Met Val 20 25 30 Pro Ser Leu Ile Lys Gln Gln Val Leu Lys Asn Val Arg Ile Asp Pro 35 40 45 Ser Ser Leu Ser Phe Asn Met Trp Lys Glu Ile Pro Ile Pro Phe Tyr 50 55 60 Leu Ser Val Tyr Phe Phe Asp Val Met Asn Pro Ser Glu Ile Leu Lys 65 70 75 80 Gly Glu Lys Pro Gln Val Arg Glu Arg Gly Pro Tyr Val Tyr Arg Glu 85 90 95 Phe Arg His Lys Ser Asn Ile Thr Phe Asn Asn Asn Asp Thr Val Ser 100 105 110 Phe Leu Glu Tyr Arg Thr Phe Gln Phe Gln Pro Ser Lys Ser His Gly 115 120 125 Ser Glu Ser Asp Tyr Ile Val Met Pro Asn Ile Leu Val Leu Gly Ala 130 135 140 Ala Val Met Met Glu Asn Lys Pro Met Thr Leu Lys Leu Ile Met Thr 145 150 155 160 Leu Ala Phe Thr Thr Leu Gly Glu Arg Ala Phe Met Asn Arg Thr Val 165 170 175 Gly Glu Ile Met Trp Gly Tyr Lys Asp Pro Leu Val Asn Leu Ile Asn 180 185 190 Lys Tyr Phe Pro Gly Met Phe Pro Phe Lys Asp Lys Phe Gly Leu Phe 195 200 205 Ala Glu Leu Asn Asn Ser Asp Ser Gly Leu Phe Thr Val Phe Thr Gly 210 215 220 Val Gln Asn Ile Ser Arg Ile His Leu Val Asp Lys Trp Asn Gly Leu 225 230 235 240 Ser Lys Val Asp Phe Trp His Ser Asp Gln Cys Asn Met Ile Asn Gly 245 250 255 Thr Ser Gly Gln Met Trp Pro Pro Phe Met Thr Pro Glu Ser Ser Leu 260 265 270 Glu Phe Tyr Ser Pro Glu Ala Cys Arg Ser Met Lys Leu Met Tyr Lys 275 280 285 Glu Ser Gly Val Phe Glu Gly Ile Pro Thr Tyr Arg Phe Val Ala Pro 290 295 300 Lys Thr Leu Phe Ala Asn Gly Ser Ile Tyr Pro Pro Asn Glu Gly Phe 305 310 315 320 Cys Pro Cys Leu Glu Ser Gly Ile Gln Asn Val Ser Thr Cys Arg Phe 325 330 335 Ser Ala Pro Leu Phe Leu Ser His Pro His Phe Leu Asn Ala Asp Pro 340 345 350 Val Leu Ala Glu Ala Val Thr Gly Leu His Pro Asn Gln Glu Ala His 355 360 365 Ser Leu Phe Leu Asp Ile His Pro Val Thr Gly Ile Pro Met Asn Cys 370 375 380 Ser Val Lys Leu Gln Leu Ser Leu Tyr Met Lys Ser Val Ala Gly Ile 385 390 395 400 Gly Gln Thr Gly Lys Ile Glu Pro Val Val Leu Pro Leu Leu Trp Phe 405 410 415 Ala Glu Ser Gly Ala Met Glu Gly Glu Thr Leu His Thr Phe Tyr Thr 420 425 430 Gln Leu Val Leu Met Pro Lys Val Met His Tyr Ala Gln Tyr Val Leu 435 440 445 Leu Ala Leu Gly Cys Val Leu Leu Leu Val Pro Val Ile Cys Gln Ile 450 455 460 Arg Ser Gln Val Gly Ala Gly Gln Arg Ala Ala Arg Ala Asp Ser His 465 470 475 480 Ser Leu Ala Cys Trp Gly Lys Gly Ala Ser Asp Arg Thr Leu Trp Pro 485 490 495 Thr Ala Ala Trp Ser Pro Pro Pro Ala Ala Val Leu Arg Leu Cys Arg 500 505 510 Ser Gly Ser Gly His Cys Trp Gly Leu Arg Ser Thr Leu Ala Ser Phe 515 520 525 Ala Cys Arg Val Ala Thr Thr Leu Pro Val Leu Glu Gly Leu Gly Pro 530 535 540 Ser Leu Gly Gly Gly Thr Gly Ser 545 550

Claims (39)

What is claimed is:
1. A method of increasing lipid efflux from an ocular tissue, comprising the step of delivering to the tissue a nuclear hormone receptor ligand.
2. The method of claim 1, wherein said ocular tissue is retinal pigment epithelium (RPE), Bruch's membrane, or both.
3. The method of claim 1, wherein said nuclear hormone receptor is thyroid hormone receptor.
4. The method of claim 3, wherein said ligand of thyroid hormone receptor is 3,5,3′-L-triiodothyronine (T3), TRIAC (3-triiodothyroacetic acid), GC-1, KB141, 3,5 dimethyl-3-isopropylthyronine, or a mixture thereof.
5. The method of claim 1, wherein said nuclear hormone receptor is liver X receptor.
6. The method of claim 5, wherein said ligand of liver X receptor is 22 (R) hydroxycholesterol, acetyl-podocarpic dimer, T0901317, GW3965 (12), 24(S),25-epoxycholesterol, 24(R),25-epoxycholesterol, 22(R)-ol-24(S),25-epoxycholesterol, 22(S)-ol,24(R),25-epoxycholesterol, 24(S),25-iminocholesterol, methyl-H-cholenate, dimethyl-hydroxycholenamide, 24(S)-hydroxycholesterol, 24(R)-hydroxycholesterol, 22(S)-hydroxycholesterol, 22(R),24(S)-dihydroxycholesterol, 25-hydroxycholesterol, 24(S),25-dihydroxycholesterol, 24(R),25-dihydroxycholesterol, 24,25-dehydrocholesterol, 7(α)-ol,24(S),25-epoxycholesterol, 7(β)-ol,24(S),25-epoxycholesterol, 7k,24(S),25-epoxycholesterol, 7(α)-hydroxycholesterol, 7-ketocholesterol, cholesterol, 5,6-24(S),25-diepoxycholesterol, or a mixture thereof.
7. The method of claim 1, wherein said nuclear hormone receptor is retinoid X receptor.
8. The method of claim 7, wherein said ligand of retinoid X receptor is 9 cis-retinoic acid, AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid], AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid], AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-tetrahydronaphthalen-2-yl) (5 carboxypyrid-2-yl)sulfide], LGD346, LG100268, LG100754, BMS649, bexaroteneR (4-[1-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl) ethenyl] benzoic acid), or a mixture thereof.
9. The method of claim 1, wherein said ocular tissue is comprised in an individual.
10. The method of claim 9, wherein said individual is afflicted with macular degeneration.
11. The method of claim 10, wherein said macular degeneration is age-related macular degeneration.
12. The method of claim 9, wherein said individual is afflicted with Stargardts disease (fundus flavimaculatus).
13. A method of increasing reverse cholesterol transport in an ocular tissue, comprising the step of delivering to the tissue at least one ligand of a nuclear hormone receptor.
14. The method of claim 13, wherein said ocular tissue is retinal pigment epithelium (RPE), Bruch's membrane, or a combination thereof.
15. The method of claim 13, wherein said nuclear hormone receptor is thyroid hormone receptor.
16. The method of claim 15, wherein said ligand of thyroid hormone receptor is T3, TRIAC (3-triiodothyroacetic acid), GC-1, K1141, 3,5 dimethyl-3-isopropylthyronine, or a mixture thereof.
17. The method of claim 13, wherein said nuclear hormone receptor is liver X receptor.
18. The method of claim 17, wherein said ligand of liver X receptor is 22 (R) hydroxycholesterol, acetyl-podocarpic dimer, T0901317, GW3965 (12), 24(S),25-epoxycholesterol, 24(R),25-epoxycholesterol, 22(R)-ol-24(S),25-epoxycholesterol, 22(S)-ol,24(R),25-epoxycholesterol, 24(S),25-iminocholesterol, methyl-H-cholenate, dimethyl-hydroxycholenamide, 24(S)-hydroxycholesterol, 24(R)-hydroxycholesterol, 22(S)-hydroxycholesterol, 22(R),24(S)-dihydroxycholesterol, 25-hydroxycholesterol, 24(S),25-dihydroxycholesterol, 24(R),25-dihydroxycholesterol, 24,25-dehydrocholesterol, 7(α)-ol,24(S),25-epoxycholesterol, 7β)-ol,24(S),25-epoxycholesterol, 7k,24(S),25-epoxycholesterol, 7(α)-hydroxycholesterol, 7-ketocholesterol, cholesterol, 5,6-24(S),25-diepoxycholesterol, or a mixture thereof.
19. The method of claim 13, wherein said nuclear hormone receptor is retinoid X receptor.
20. The method of claim 19, wherein said ligand of retinoid X receptor is 9 cis-retinoic acid, AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid], AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid], AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-tetrahydronaphthalen-2-yl) (5 carboxypyrid-2-yl)sulfide], LGD346, LG100268, LG100754, BMS649, bexaroteneR (4-[1-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl) ethenyl] benzoic acid), or a mixture thereof.
21. The method of claim 13, wherein said ocular tissue is comprised in an individual.
22. The method of claim 21, wherein said individual is afflicted with macular degeneration.
23. The method of claim 22, wherein said macular degeneration is age-related macular degeneration.
24. The method of claim 21, wherein said individual is afflicted with Stargardts disease (fundus flavimaculatus).
25. A method of treating macular degeneration (AMD) in an individual, comprising the step of delivering to the individual a ligand of a nuclear hormone receptor.
26. The method of claim 25, wherein said delivering occurs under conditions wherein reverse cholesterol transport is upregulated.
27. The method of claim 25, wherein said nuclear hormone receptor is thyroid hormone receptor.
28. The method of claim 27, wherein said ligand of thyroid hormone receptor is T3, TRIAC (3-triiodothyroacetic acid), GC-1, KB 141, 3,5 dimethyl-3-isopropylthyronine, or a mixture thereof.
29. The method of claim 25, wherein said nuclear hormone receptor is liver X receptor.
30. The method of claim 29, wherein said ligand of liver X receptor is 22 (R) hydroxycholesterol, acetyl-podocarpic dimer, T0901317, GW3965 (12), 24(S),25-epoxycholesterol, 24(R),25-epoxycholesterol, 22(R)-ol-24(S),25-epoxycholesterol, 22(S)-ol,24(R),25-epoxycholesterol, 24(S),25-iminocholesterol, methyl-H-cholenate, dimethyl-hydroxycholenamide, 24(S)-hydroxycholesterol, 24(R)-hydroxycholesterol, 22(S)-hydroxycholesterol, 22(R),24(S)-dihydroxycholesterol, 25-hydroxycholesterol, 24(S),25-dihydroxycholesterol, 24(R),25-dihydroxycholesterol, 24,25-dehydrocholesterol, 7(α)-ol,24(S),25-epoxycholesterol, 7β)-ol,24(S),25-epoxycholesterol, 7k,24(S),25-epoxycholesterol, 7(α-hydroxycholesterol, 7-ketocholesterol, cholesterol, 5,6-24(S),25-diepoxycholesterol, or a mixture thereof.
31. The method of claim 25, wherein said nuclear hormone receptor is retinoid X receptor.
32. The method of claim 31, wherein said ligand of retinoid X receptor is 9 cis-retinoic acid, AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid], AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid], AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-tetrahydronaphthalen-2-yl) (5 carboxypyrid-2-yl)sulfide], LGD346, LG100268, LG100754, BMS649, bexaroteneR (4-[1-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl) ethenyl] benzoic acid), or a mixture thereof.
33. The method of claim 25, wherein said macular degeneration is age-related macular degeneration.
34. A kit for the treatment of macular degeneration, housed in a suitable container, comprising a ligand of a nuclear hormone receptor.
35. The kit of claim 34, wherein said nuclear hormone receptor is TR, RXR, LXR, or a combination thereof.
36. The kit of claim 34, wherein said ligand is T3, 9-cis retinoic acid, (R) hydroxycholesterol, or a mixture thereof.
37. The kit of claim 34, wherein said ligand is TRIAC (3-triiodothyroacetic acid, GC-1, KB141, 3,5 dimethyl-3-isopropylthyronine, acetyl-podocarpic dimer, T0901317, GW3965 (12), 24(S),25-epoxycholesterol, 24(R),25-epoxycholesterol, 22(R)-ol-24(S),25-epoxycholesterol, 22(S)-ol,24(R),25-epoxycholesterol, 24(S),25-iminocholesterol, methyl-H-cholenate, dimethyl-hydroxycholenamide, 24(S)-hydroxycholesterol, 24(R)-hydroxycholesterol, 22(S)-hydroxycholesterol, 22(R),24(S)-dihydroxycholesterol, 25-hydroxycholesterol, 24(S),25-dihydroxycholesterol, 24(R),25-dihydroxycholesterol, 24,25-dehydrocholesterol, 7(α)-ol,24(S),25-epoxycholesterol, 7(β)-ol,24(S),25-epoxycholesterol, 7k,24(S),25-epoxycholesterol, 7(α)-hydroxycholesterol, 7-ketocholesterol, cholesterol, 5,6-24(S),25-diepoxycholesterol, AGN 191659 [(E)-5-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-2-thiophenecarboxylic acid], AGN 191701 [(E) 2-[2-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthyl)propen-1-yl]-4-thiophene-carboxylic acid], AGN 192849 [(3,5,5,8,8,-pentamethyl-5,6,7,8-tetrahydronaphthalen-2-yl) (5 carboxypyrid-2-yl)sulfide], LGD346, LG100268, LG100754, BMS649, bexaroteneR (4-[1-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl) ethenyl] benzoic acid), or a mixture thereof.
38. The kit of claim 34, wherein said kit comprises a pharmaceutically acceptable excipient.
39. A method of treating macular degeneration (AMD) in an individual, comprising the steps of:
identifying a ligand for a nuclear hormone receptor; and
delivering said ligand to said individual.
US10/313,641 2001-12-07 2002-12-06 Treatment for age-related macular degeneration (AMD) Abandoned US20030162758A1 (en)

Priority Applications (5)

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US11/055,309 US7470660B2 (en) 2001-12-07 2005-02-10 Treatment for dark adaptation
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Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SCHWARTZ, DANIEL M.;DUNCAN, KEITH G.;BAILEY, KATHY R.;AND OTHERS;REEL/FRAME:014387/0848;SIGNING DATES FROM 20030724 TO 20030807

STCB Information on status: application discontinuation

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